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> 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) Tue, 18 Jul 2023 09:44:58 +0000 OJS 60 Knowledge and Practice of Glucose Self-Monitoring Devices among Patients with Diabetes <p><strong>Background</strong>: With blood glucose self-monitoring, patients may assess how well their glucose level is controlled, and change their&nbsp; treatment plan as advised by their physicians. The development and increasing availability of different devices that are readily accessible&nbsp; plays a significant role in glycemic control and prevention of complications through early recognition with proper practice.</p> <p><strong>Methods</strong>: This&nbsp; observational cross-sectional study includes patients with diabetes attending Khartoum North Diabetes and Endocrinology Hospital&nbsp; and was carried out in April–July 2021 using convenient sampling via questionnaires obtained and filled by data collectors through&nbsp; interviews. Data analysis was done using SPSS software.</p> <p><strong>Results</strong>: Out of 125 total patients, 82 had prior basic knowledge about glucose&nbsp; selfmonitoring devices. Twenty-four patients were using it regularly, and only seven were using it daily. Fifty-one patients had never used&nbsp; any device before. Fifty-five patients owned a device, and the rest borrowed or used devices available at healthcare centers or clinics,&nbsp; pharmacies, relatives’ or neighbors’ devices. Factors hindering the use of devices included financial difficulties and lack of education.&nbsp; Most frequent users had a stable occupation. Just below half of the patients using devices had good practice techniques with significant&nbsp; association with higher level of education. The rest had poor practice technique that was associated with lower level of education.&nbsp;&nbsp;</p> <p><strong>Conclusion</strong>: Utilization of glucose self-monitoring devices is prevalent among patients with diabetes. However, many challenges require&nbsp; attention to facilitate ongoing selfuse with proper practice inline with education and access.&nbsp;&nbsp;</p> Sami Mohamed, Mutasim Mukhtar, Khalid Aseed, Duaa Osman, Mujtaba Dawelbait, Ahmed Saeed, Nasma Ahmed, Nihal Fadul, Rogia Idriss Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Climate Change As a Significant Factor to the Aggravation of Coronary Artery Disease Among Elderly: A Basis for Emphasizing Community-based Self-care Measures <p><strong>Background</strong>: This research study explored the lived experience of the elderly with coronary artery disease (CAD) relevant to the effects of&nbsp; climate change as a basis for enhanced and strengthened community-based self-care measures.</p> <p><strong>Methods</strong>: A descriptive&nbsp; phenomenological design was employed in the study. Consented face-to-face interview sessions with audio recordings were conducted&nbsp; to gather rich information. The data collected from 28 participants were analyzed using the modified Stevick-Colaizzi-Keen method.&nbsp;&nbsp;&nbsp;</p> <p><strong>Results</strong>: Three themes emerged upon a thorough analysis of the results: (1) elucidating the elderly’s perception of climate change; (2)&nbsp; unveiling the effects of climate change on CAD; and (3) managing health-related behaviors in a changing environment. Evidence has&nbsp; revealed that climate change causes and aggravates this disease. CAD manifestations worsen when an elderly person is exposed to&nbsp; sudden changes in weather conditions, where various signs and symptoms are evident.</p> <p><strong>Conclusion</strong>: In conclusion, elderly clients have an&nbsp; awareness of the concept of climate change and its physiologic effects on CAD; hence, employment of practical self-care measures&nbsp; and practices in managing manifestations, significantly helps them adapt and cope with the adverse effects climate change brings.&nbsp;</p> Eladio Martin S. Gumabay, Karen Mae S. Alcantara, Jaylord G. Ugaddan, Dexter C. Centeno Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Attitudes of Patients Attending Omdurman Teaching Hospital VCT Center, Sudan toward HIV/AIDS Voluntary Counseling and Testing Services <p><strong>Background</strong>: Despite the availability of HIV/AIDS voluntary counselling and testing services in Omdurman Teaching Hospital, the level of&nbsp; uptake remains low, and the prevalence of HIV/AIDS in Sudan is still high. This situation suggests that there may be some underlying&nbsp; factors, such as patients’ attitudes toward the services provided, that are affecting their willingness to access them. Therefore, this study&nbsp; aimed to assess the attitude of patients attending HIV/AIDS voluntary counselling and testing services in Omdurman Teaching Hospital, Sudan.</p> <p><strong>Methods</strong>: A descriptive hospital-based study was conducted at Omdurman Teaching Hospital, Sudan. All patients attending HIV/AIDs&nbsp; counseling and voluntary services center were invited to participate in this study, and of the 200 invited, 150 patients participated with a&nbsp; response rate of 75%. Data were collected using a structured interview questionnaire and then analyzed by SPSS (version 23).</p> <p><strong>Results</strong>: The findings revealed that many patients (92%) have a positive attitude toward HIV voluntary counselling and testing and&nbsp; believed that the shared information is informative and influential. It was also observed that 80% of the patients who received counselling had lower levels of social and psychological stress and stigma.</p> <p><strong>Conclusion</strong>: The study highlighted the positive attitude of&nbsp; patients to utilize HIV/AIDS voluntary counselling and testing services which reduces the social and psychological stresses and stigma&nbsp; among HIV patients. Females and Muslim patients had a positive attitude.</p> Maha Hamed Mohamed Ali, Osman Babiker Osman, Adam Dawria Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Chronotype, Daytime Sleepiness, and Related Factors Effects on Skipping Classroom among Medical Students in Tabuk <p><strong>Background</strong>: Lecture attendance is very critical in medical practice. Good sleep hygiene is crucial for academic performance. Therefore,&nbsp; this research aimed to assess the relationship between daytime sleepiness and the chronotype, and skipping the classroom.</p> <p><strong>Methods</strong>: A cross-sectional study was conducted among medical Students in Tabuk from April 2022 to July 2022. Three hundred and&nbsp; thirty-four medical students were randomly selected. A standardized questionnaire based on the daytime sleepiness scale, morningness– eveningness questionnaire, and risk for skipping classrooms was used. The students detailed their sleeping habits for two weeks and&nbsp; then responded to the questionnaire distributed directly by the researchers who attended to solve any difficulties.</p> <p><strong>Results</strong>: Out of the 334&nbsp; students,74.7% skipped the classroom last month. The most common reason for absence was the lecturer directly reading from the&nbsp; slide show (72.8%), followed by late lectures (67.8%), lecturers’ presentation skills (65.6%), and lack of interest (57.9%). Daytime sleepiness&nbsp; was evident in 40.1% of the students and was associated with skipping lectures (Wald, 3.86, P-value, 0.049, and 95% CI,&nbsp; 0.19–0.91). The majority were intermediate chronotypes (66.4%), followed by evening chronotypes (24.2%) with no association with&nbsp; skipping classrooms.</p> <p><strong>Conclusion</strong>: Skipping lectures is common among medical students in Tabuk City, Saudi Arabia; the causes were&nbsp; lecture timing, daytime sleepiness, and lecturers’ presentation skills. Most students were an intermediate chronotype that was not&nbsp; associated with classroom absence. Further larger multi-center studies are needed.&nbsp;</p> Turki Aqahtani, Abdulaziz Albalawi, Jalawi Alotaibi, Atheer Alshareef, Tariq Alrasheed, Hyder Mirghani, Iman Mirza, Amerah Alatawi, Hani Albalawi, Mohammed Sheik Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Expression of Programmed Death Ligand-1 and Correlation with Clinicopathological Features and CD8 Infiltration in Breast Cancer <p><strong>Background</strong>: Breast cancer (BC) is considered one of the most diversified types of tumors, characterized by a high mutational burden in&nbsp; the tumor milieu and a lack of immune cell makeup. The programmed death receptor-1 (PD -1)/programmed death ligand-1 (PD -L1) axis&nbsp; has been identified as a new target in the field of immunotherapy because, when activated, they worsen the future scenarios of the disease by helping tumor cells (TC) to escape immune surveillance. This study aims to investigate the expression of PD-L1 in BC tissues&nbsp; from Sudanese ladies and correlate its expression with clinicopathological features and the infiltration of CD8+T lymphocytes by&nbsp; immunohistochemistry (IHC).</p> <p><strong>Methods</strong>: One hundred and fifty archived BC blocks were collected from National Public Health Laboratory from January 2019 to August&nbsp; 2020. Data regarding age, TNM staging, grade, and hormonal status were considered. Tissue sections were examined using IHC to&nbsp; determine the expression of PD-L1 and CD8.</p> <p><strong>Results</strong>: Among one hundred and fifty BC samples, 73 (48.7%) were TNBCs, and 77 (51.3%)&nbsp; were hormone-positive BCs. PD-L1 was significantly associated with BC subtypes, especially TNBCs (P = 0.001), a similar significant&nbsp; association was shown with CD8 infiltration (P = 0.006). None of the clinicopathological features were associated with PD-L1 expression.</p> <p><strong>Conclusion</strong>: PD-L1 expression is strongly associated with TNBC’s and linked to CD8+ cells infiltration to the tumor milieu. Moreover, no&nbsp; correlation has been observed between the expression of PD-L1 and clinicopathological features in this study.</p> Shahenaz S. Salih, Mohammed S. Abdelaziz, Altaf S. Mosad., Ibtihal M. Abdelhag, R.E. Elmassry, Nadia A. Eldawi Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Serum Cytokine Levels As Critical Parameters in Early Diagnosis of Disease Progression in COVID-19: A Pilot Study <p><strong>Background</strong>: The severity of Coronavirus disease 2019 (COVID-19) has been proposed to be associated with cytokine dysregulation. A&nbsp; significant number of patients become serious and need intensive care in hospitals.</p> <p><strong>Methods</strong>: The concentrations of cytokines interleukin (IL-6, IL-10) and tumor necrosis factor (TNF) were estimated using enzyme-linked&nbsp; immunosorbent assay (ELISA) in serum samples of 60 adult patients infected with SARS-CoV-2 along with 50 healthy controls of the same&nbsp; age. The mean age of the subjects was 50-52 years and included an equal number of males and females. The patients were further&nbsp; grouped as severe (38 patients) and non-severe cases (22 patients).</p> <p><strong>Results</strong>: The mean serum cytokine levels were significantly higher in the COVID-19 patients than in the healthy controls. IL-6 was&nbsp; excessively elevated in comparison to IL-10 and TNF. Comparative analysis of severe versus non-severe cases revealed only slight&nbsp; alterations in the cytokine levels: IL-6 being the most elevated in severe cases. The concentration of the liver enzyme ALT was higher than&nbsp; AST in both severe and non-severe cases. The mean concentration of serum electrolytes (Na, K, and Ca) did not vary much between&nbsp; the patients and healthy controls.</p> <p><strong>Conclusion</strong>: There was a significant positive correlation between the levels of cytokines serum biomarkers in COVID-19 patients. It may&nbsp; be suggested that early detection of cytokines, especially IL-6 and serum biomarkers can help predict disease prognosis and severity in&nbsp; COVID-19 patients. </p> Walaa Mohammedsaeed, Ziab Zakey Alahmadey, Nikhat Manzoor Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Exploring Work-related Anxiety Among Newly Graduated Nurses in the Riyadh Region <p><strong>Background</strong>: Work-related anxiety among nurses has been linked to various issues, including a heavy workload, work-related conflict, a&nbsp; lack of resources, and stress. This research aims to explore work-related anxiety among recently graduated nurses in Saudi Arabia’s Riyadh region.</p> <p><strong>Methods</strong>: A descriptive, cross-sectional, and relational research design examined work-related anxiety among newly graduated nurses. A&nbsp; sample of 400 nurses was recruited from five Saudi hospitals in the Riyadh region. This study used the job anxiety scale ( JAS) as a study&nbsp; tool. The tool is a self-rating scale of 70 items for assessing job anxiety but only 25 items were applied to this research. A self- administered questionnaire was used to gather demographic information.</p> <p><strong>Results</strong>: This study revealed that there was, overall, low work-related anxiety among the nurse participants. On the one hand, age,&nbsp; gender, educational qualification, job experience, workplace, and work scheduling (hours per week) were found to impact work-related&nbsp; anxiety substantially. On the other hand, work position, nationality, unit of care, and marital status were found to play no significant role&nbsp; in work-related anxiety.</p> <p><strong>Conclusion</strong>: The study’s findings indicate the importance of paying more attention to workplace anxiety. As&nbsp; anxiety may affect nurses’ ability to attend to the needs of patients in their care units, addressing it can reduce burnout and the desire to quit. Changes in work processes, care models, and leadership may be effective in creating a supportive environment that decreases&nbsp; stress and anxiety, promote learning, and provides patients with optimal and safe nursing care. Health policymakers and nurse managers&nbsp; in Saudi Arabia should develop particular intervention programs to reduce work-related anxiety among newly graduated&nbsp; nurses. Managers must seek techniques that help to adapt the present environment to the needs of nurses, as well as approaches that&nbsp; offer newly graduating nurses essential assistance, such as clinical supervision.&nbsp;</p> Kholoud R. Alrashedi, Amira Boshra Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Assessment of Cardiovascular Risk Factors Among Sudanese Patients with Type 2 Diabetes <p><strong>Background</strong>: Individuals with type 2 diabetes who have optimum condition management are exposed to a significantly higher risk of&nbsp; developing cardiovascular disease (CVD) compared to those who do not have diabetes. People with diabetes are estimated to have a&nbsp; fourfold greater risk of developing CVD than people without diabetes. CVD risk factors other than diabetes include older age, obesity&nbsp; hypertension, dyslipidemia, smoking, and a family history of coronary or kidney diseases.</p> <p><strong>Objectives</strong>: The study aims to assess the&nbsp; cardiovascular risk factors among type2 diabetes at Ribat Hospital Diabetes Clinic, Sudan.</p> <p><strong>Methods</strong>: T2 DM patients were evaluated for&nbsp; the presence of CVD risk factors by using data collecting form to extract data verbally and from patients’ files.</p> <p><strong>Results</strong>: Out of 147 T2 DM&nbsp; files, 92 (61.7 %) were female, 57 (38.3 %) were male, and 58 (38.9 %) patients were ≥ 60 year old. Patients who had poor glycemic control&nbsp; were 112 (75.2 %) and those who met the glycemic target were only 37 (24.8 %). Older age (P = 0.01) and diabetes duration (P = 0.026)&nbsp; were associated with poor glycemic control. Prevalence of hypertension was 61 (40.9 %), dyslipidemia 31 (20.8 %), and physical inactivity&nbsp; 112 (75.2 %). All patients had at least one CVD risk factor and those having all three risk factors were 48 (32.2 %).</p> <p><strong>Conclusion</strong>: All T2 DM&nbsp; diabetic patients in RHDC had at least one CVD risk factor and almost a third of them had all three risk factors. Poor glycemic control,&nbsp; physical inactivity, hypertension, and age ≥ 60 had the higher prevalence of CVD risk factors.&nbsp;&nbsp;</p> Hisham Mohammed Abdelrahim, Abdelhaleem Mustafa Madani, Tarig Mohammed El-Hadiyah Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 A Review of Medical Microbiology Curriculum Integration in the Integrated Modular System of Education At Medical Schools in Saudi Arabia <p>Medical or clinical microbiology has its importance in the curriculum of undergraduate degree programs of all medical colleges of the&nbsp; Kingdom of Saudi Arabia. This review describes the preclinical medical microbiology teaching at Prince Sattam bin Abdulaziz University as&nbsp; a hybrid module, it is integrated into blocks or system-based courses. Various teaching and practical approaches were discussed and&nbsp; elaborated. Several challenges and potential suggestions were also emphasized for innovation in an integrated system of teaching.</p> Mohammed Sarosh Khan, Muhammad Musthafa Poyil Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 The Impact of Incisional Hernia Repair on the Quality of Life: A Narrative Review <p><strong>Background</strong>: Incisional hernias represent a common complication following a midline incision, generating impairment, lower quality of&nbsp; life, and social costs. The aim of this narrative review is to determine in which manner risk factors – such as age, gender, postoperative&nbsp; complications, and even the overall health system – impact the satisfaction and expectations of the patients.</p> <p><strong>Methods</strong>: A literature search was performed through PubMed, Web of Science, and SpringerLink, addressing both international and&nbsp; national articles. Only full-text articles published in the last 12 years were chosen. Each individual positive or negative factor was then&nbsp; targeted.</p> <p><strong>Results</strong>: Statistically, the majority of patients were satisfied with the outcomes of the reparative surgery. Even so, complications can still&nbsp; occur, which are more likely to appear in the early postoperative stages. In most of these cases, the patients complained of strenuous&nbsp; movement, chronic pain, or recurrence, leaving the option of another surgical repair up to the patient’s wishes. On the one hand it seems&nbsp; that robotic-assisted surgery (RAS), absorbable sutures, suture fixation without tacks, and the male gender were associated with a&nbsp; better quality of life and less recurrence or other complications. On the other hand, lack of communication between patients and health personnel, chronic health diseases, and the female gender were linked to a tendency of developing more complications and&nbsp; therefore, a lower quality of life.</p> <p><strong>Conclusion</strong>: Statistically, in most of the cases, the patients were satisfied with the results. While it is safe&nbsp; to say that an incisional hernia repair increases the quality of life, there is still a small, but significant percentage of people that do not&nbsp; benefit from it as much as they expected. More awareness should be raised and the communication between patients and health&nbsp; personnel improved.&nbsp; </p> Mara Ioana Pătrașcu, Daniel Ion, Alexandra Bolocan, Dan Nicolae Păduraru, Octavian Andronic Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Recurring Outbreaks of Lassa Fever in Nigeria: Understanding the Root Causes and Strategies for the Future <p>Lassa fever is a severe public health problem in Nigeria with far-reaching political, social, cultural, and religious ramifications. Thus, a&nbsp; further understanding of the disease is critical. Despite attempts to end the viral epidemic, the illness has persisted, leading to several&nbsp; major outbreaks in decades. Additionally, the country’s epidemic in 2019–2020 set a new global record for the number of Lassa fever&nbsp; cases. This year, 244 cases and 37 deaths had been reported as of January 2023. To identify gaps and provide recommendations for the&nbsp; complete eradication of Lassa fever in the country. This paper investigates the underlying causes of the continuous outbreaks of the illness in Nigeria and the measures to prevent it. The frequent outbreaks of Lassa fever in Nigeria have been linked to several factors,&nbsp; including inadequate waste management, poor sanitation, restricted access to healthcare, and abject poverty. The reoccurring outbreaks&nbsp; are also attributed to a lack of political will, funding, poor coordination and communication, and low public awareness of the illness and&nbsp; its prevention. To effectively stop outbreaks of Lassa fever in Nigeria, the government and partners must continuously put into practice&nbsp; tried-and-true prevention measures such as improved surveillance to detect outbreaks earlier, increased funding and resources to&nbsp; support effective control measures, better primary healthcare facilities and training for healthcare professionals, heightened community&nbsp; engagement and education to raise awareness, and more effective vector control methods to reduce rodent populations, while looking&nbsp; for innovative approaches and dealing with the underlying social and economic problems contributing to the viral persistence.&nbsp;</p> Bashar Haruna Gulumbe, Uzairu Aminu, Usman Umar Liman, Abdulrakib Abdulrahim, Zaharaddin Muhammad Kalgo Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 Letter: Inappropriate Prescribing of Cefixime 400 mg Every 12 Hours Dose <p>No Abstract</p> Durr-e-Shahwar Siddiqui Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000 The Importance of Peer Review and Guidelines for Becoming a Reviewer <p>No Abstract.</p> Emily Choynowski Copyright (c) 2023 Tue, 18 Jul 2023 00:00:00 +0000