Sudan Journal of Medical Sciences

“Together We Build Our Health”: Paving Way Forward Through Analyzing the Context and Ensuring Wide Participation in the First and Second Health Forums in Sudan

Nazik Elmalaika Obaid Seid Ahmed Husain — 2022-10-03

Shaping Healthcare System Under Industry 5.0: Trends and Barriers

Zeeshan Asim — 2022-10-04

Effectiveness of Health Awareness Module on Pregnant Women’s Perception on and Experience of Constipation at Saad Abu Alela – University Hospital, 2017

Faiza Taha — 2022-10-03

Background: Pregnancy predisposes women to developing constipation, and
hormonal and mechanical factors, sedentary lifestyle, and alteration of diet augments
the condition, leading to discomforts experienced by pregnant women. However,
this can be controlled through proper education and lifestyle modification. The
present study aims to check the effect of health awareness education module on
the reduction of constipation among pregnant women.
Methods: A quasi-experimental study design was used. One hundred and twentyfive pregnant women were randomly selected from Saad Abu Alela Hospital between
January and March 2017), and based on the ROME II criteria, 59 of them were found to
have constipation. After obtaining consent from the women, health awareness module
(information about constipation, dietary measures, increased fluid intake, and exercise)
was offered to them. Data were collected by structured close-ended questionnaire for
the knowledge, pre- and post-intervention, and checklists for the practice and follow-up
of the weekly outcome over two months. Data were analyzed, and suitable statistical
methods was used. P < 0.05 was considered as statistically significant.
Results: The overall prevalence of constipation was 47.2% with a prevalence of 4%,
6.4%, and 36.8% in the first, second, and third trimesters of pregnancy, respectively.
Pregnant women’s knowledge about constipation increased significantly from 16.9%
pre- to 92.9 post-intervention with P = 0.000. The fiber diet intake, fluid intake, and
exercise by pregnant women increased from 37.3%, 39%, and 13.6% pre- to 72.9%,
88.1%, and 49.1% post-intervention, respectively) with P = 0.001. Moreover, 46 (78%)
women were relieved of constipation post-intervention.
Conclusion: The health awareness module was very effective and significantly
increased the level of knowledge, practice, and outcomes with respect to constipation
in pregnant women.

Familial Medullary Thyroid Cancer: Five-year Review of the Most Frequent Mutations in the RET Gene: An Update

Blanca Estela Díaz Castañeda — 2022-10-03

Background: Familial Medullary Thyroid Cancer (FMTC) is hereditary in 25% of cases.
Patients with an inherited form of FMTC usually have a germline mutation in the RET
proto-oncogene (10q11.2); these mutations generally occur in exons 10 (codons 618
and 620) and 11 (codons 630, 631, and 634).
Methods: A narrative review of articles focused on the pathology of familial medullary
thyroid cancer was carried out using the next databases PubMed, ScienceDirect, BMC,
Springer, Frontiers, PMC, Wiley Online Library, Cold Spring Harbor and ELSEVIER. This
search was carried out between August and September 2021.
Results: 19 studies were selected in which the following mutations were found: five
studies (26.31%) reported mutation in exon 10; three studies (15.78%) in exon 11; three
studies in exon 13 (one of them associated with a rare mutation in exon 7) (10.52% plus
5.26%); three studies (15.78%) in exon 14; two studies (10.52%) in exon 15; two (10.52%)
in exon 16; and one (5.26%) rare FMTC NO RET. The two most frequent mutations
were in codons 620 of exon 10 and 804 of exon 14.
Conclusion: The findings of this review are consistent with the medical literature,
finding the most common RET mutations in exon 10 and codon 620. It is essential that
in patients with a presumptive diagnosis, genetic studies (identification of germline
mutations in the RET proto-oncogene, located on chromosome 10q11.2) be performed.

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Alaa Abdalla Abbas — 2022-10-03

Background: Graft survival post-kidney transplantation is of paramount importance
to patients and nephrologists. Nonadherence to immunosuppressive therapy can be
associated with deterioration of renal function and graft rejection. This study aimed
to evaluate the adherence to immunosuppressive medications in kidney transplant
patients at three centers in Khartoum, Sudan.
Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and
analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky
Medication Adherence Scale (MMAS-8) related to immunosuppressive medications
and was expressed as questions in the questionnaire; every correct answer was given
one mark, then the marks were gathered and their summation was expressed.
Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium,
and low adherence, respectively. The major factor for nonadherence was forgetfulness
affecting 36.1% of those who did not adhere. The cost of the immunosuppressive
medications did not negatively affect any of the participants’ adherence (100%).
However, a significant association was seen between adherence and occupational
status, duration of transplantation, shortage of immunosuppressants, recognizing the
name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01,
0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a
significant association with occupational status, side effects, and forgetfulness.

Evaluation of Fine-needle Aspiration Cytology (FNAC) Sensitivity Compared to PCR for Diagnosing Tuberculosis Lymphadenitis

Omar Mustafa — 2022-10-03

Background: Tuberculosis (TB) is a major healthcare burden in Sudan and other
developing countries, it is considered the second most common cause of death
from infectious diseases after those due to AIDS. In Sudan, TB lymphadenitis (TBLA)
remains one of the major health problems. This descriptive cross-sectional study was
conducted at the University of Medical Sciences and Technology (UMST) and Total
Labcare Diagnostic Center (TDC). The study aims to compare the sensitivity of Fine
Needle Aspiration Cytology (FNAC) smears with that of the Polymerase Chain Reaction
(PCR) for the diagnosis of TBLA.
Methods: Fifty-five dry smears were obtained using fine-needle aspiration (FNA) from
an enlarged lymph node. PCR was applied to detect the target gene (IS6110). MayGrunwald-Giemsa (MGG) or Diff quick stains were used.
Results: Two (4%) patients with TBLA were non-necrotic, while fifty-three of them
(96%) were necrotic. Moreover, 17 (30%) fine-needle lymph node aspiration specimens
were confirmed by PCR to be positive for Mycobacterium tuberculosis complex (MTB
complex) while 38 (70%) of them were negative.
Conclusion: There was no significant difference between the sensitivity of PCR and
that of FNAC (P-value = 0.33).

Assessment of Variation in Clinical Presentation of Visceral Leishmaniasis Among Patients Attending the Tropical Diseases Teaching Hospital in Sudan

Hammam Abdalrhman Altom Mohammed Ahmed — 2022-10-03

Background: Visceral leishmaniasis (also known as Kala-azar) is a systemic parasitic
infection with many clinical presentations. The present study assesses the variation in
presentations among patients who attended the Tropical Diseases Teaching Hospital
(TDTH) in Khartoum, Sudan.
Methods: This analytical cross-sectional, hospital-based study was conducted at the
TDTH between November 2019 and September 2020. Medical records of patients who
presented at the TDTH were reviewed using a structured data extraction checklist. The
Chi-square test was used to determine the associations between sociodemographic
and clinical presentations of patients. P-value < 0.05 was considered as statistically
significant.
Results: Out of 195 patients, 79.5% were male and 48.2% were <31 years old. Fever
was the main clinical presentation (90.2%) while 53.3% presented with weight loss
and 72.3% and 39% presented, respectively, with splenomegaly and hepatomegaly.
HIV was detected in 4.6% of the patients. RK39 was the main diagnostic test. We
found a significant association between the abdominal distention and the age of the
patients (P < 0.05) – age groups 11–20 and 41–50 years were more likely to present
with abdominal distention than other age groups.
Conclusion: There is no exact clinical presentation or routine laboratory findings that
are pathognomonic for visceral leishmaniasis; therefore, it should be considered in the
differential diagnosis of any patient with fever, weight loss, and abdominal distention,
and among patients with HIV.

Knowledge, Attitude, and Practice toward Prevention of COVID-19 Among Nursing and Midwifery Students: A cross-sectional Study in Gorgan, Northern Iran

Iman Taghizadeh Firoozjaie — 2022-10-03

Background: Healthcare providers are high-risk groups for the novel coronavirus
disease (COVID-19) infection. Nursing students are an essential part of high-risk
healthcare providers. The aim of this study was to evaluate the knowledge, attitude,
and practice of nursing and midwifery students at Golestan University of Medical
Sciences (GOUMS) toward the prevention of COVID-19.
Methods: This cross-sectional study was conducted on 174 nursing and midwifery
students of GOUMS (northeast of IRAN) in 2020. Data were gathered using an
online questionnaire comprising three parts – Knowledge (8 questions), Attitude (10
questions), and Practice (8 questions) toward the prevention of COVID-19. The range
of scores in each subscale (knowledge, attitude, and preventive practices) were 8–24,
10–50, and 8–24, respectively. Data were analyzed using the SPSS v.16 software. The
Mann–Whitney and Kruskal–Wallis tests were used for the analysis.
Results: Overall, in this study, nursing and midwifery students had a good knowledge
(mean score: 23.19 ± 2.56), a positive attitude (mean score: 45.48 ± 4.21), and
appropriate practice (mean score: 23.30 ± 3.51) regarding COVID-19 prevention. Also,
the results revealed a positive correlation between knowledge and attitude (r = 0.1, P
= 0.18) and attitude and practice (r = 0.2, P = 0.01) among the students.
Conclusion: The findings demonstrated a good preventive knowledge, attitude, and
practice toward COVID-19 among nursing and midwifery students.

Variations of Arterial Supply of the Liver: C.T. Angiographic Study Among Sudanese Adults

Nidal Abubaker Harun — 2022-10-04

Hepatobiliary surgery through laparoscopic approach is becoming a routine.
Knowledge of extrahepatic arterial tree is essential for surgical and imaging
procedures. Anatomical complexity is expected since the liver is developed by
mergingof lobules with its separate blood supply. This makes a wide range of variations
in the pattern of vascular arrangement and so reinforces the need for an accurate
understanding of full spectrum of variations. This study aimed to investigate the
variations in origin and distribution of extrahepatic arterial supply. Fifty volunteers (32
males and 18 females) aged 20–70 years were randomly recruited from the department
of CT scan in Al Amal Hospital, Khartoum North, Sudan. The patients were already
candidates for CT angiography with contrast for conditions other than hepatobiliary
diseases. The reported data is related to those who accepted to participate in the
study. Patients with history of hepatobiliary disease were excluded. 3D views of the
scans were treated and the extrahepatic arterial tree was traced in a computer-based
software. Key findings suggest that Michel’s classification was considered the standard
template for description – 76% of them showed Michel’s type I classification. Types
III and V constituted about 2%. About 4% of the cases were represented by types
VI and IX. Other types of variations constituted about 12%. To conclude, although
type I classification which describes the textbook pattern of hepatic artery distribution
was significantly detected among the Sudanese population, other variants were to be
considered since they are related to major arteries like aorta and superior mesenteric.

Sero-molecular Epidemiology of Hepatitis E Virus in Blood Donors, Gezira State, Sudan: A Cross-sectional Study

Nassir Abakar Babiker — 2022-10-04

Background: Hepatitis E virus (HEV) is a hepatotropic pathogen that causes significant
morbidity and mortality in humans. It is an important causative agent of viral hepatitis
outbreaks. This study investigates the serological and molecular prevalence of HEV
in blood donors attending the Central Blood Bank in Wad Medani City in Gezira State,
Sudan.
Methods: The study adopted a cross-sectional descriptive design. A structured
questionnaire was used to collect data concerning demographic information and risk
factors associated with HEV transmission. All enrolled participants (N = 300) were
screened for HEV IgG antibodies using commercial ELISA kits, then strong positive
samples (N = 84) were selected and rescreened for HEV IgM and HEV RNA by RT
PCR. SPSS version 24.0 was used for analysis.
Results: Out of 300 male participants, 36.3% (109/300) were positive for HEV IgG.
However, only one participant was IgM positive, while the HEV RNA was negative.
The highest prevalence rates of the virus were 42 (44.6%) among the age group
of 31–40 years, 20 (48.8%) in those who consumed food from outside, 13 (50%) in
three to four multiple blood donations, and 5 (62.5%) in those who consumed water
from the river source. A significant association of HEV IgG prevalence concerning the
occupation of the participants being students or farmers was detected using univariate
and multivariate analysis (P-value = 0.007).

Conclusion: High prevalence of HEV IgG was demonstrated among the healthy
blood donors in this study. Given the possibility of HEV transmission by transfusion
from donors to recipients, we recommend that routine screening for HEV should
be adopted by blood banks in Sudan.

Computational Screening of Repurposed Drugs Targeting Sars-Cov-2 Main Protease By Molecular Docking

Yow Hui Yin — 2022-10-04

Background: COVID-19 (Coronavirus disease 2019) is caused by the severe acute
respiratory syndrome coronavirus type 2 (SARS-CoV-2), which poses significant global
health and economic crisis that urges effective treatment.
Methods: A total of 11 molecules (baricitinib, danoprevir, dexamethasone, hydroxychloroquine, ivermectin, lopinavir, methylprednisolone, remdesivir, ritonavir and
saridegib, ascorbic acid, and cepharanthine) were selected for molecular docking
studies using AutoDock VINA to study their antiviral activities via targeting SARS-CoV’s
main protease (Mpro), a cysteine protease that mediates the maturation cleavage of
polyproteins during virus replication.
Results: Three drugs showed stronger binding affinity toward Mpro than N3 (active
Mpro inhibitor as control): danoprevir (–7.7 kcal/mol), remdesivir (–8.1 kcal/mol), and
saridegib (–7.8 kcal/mol). Two primary conventional hydrogen bonds were identified in
the danoprevir-Mpro complex at GlyA:143 and GlnA:189, whereas the residue GluA:166
formed a carbon–hydrogen bond. Seven main conventional hydrogen bonds were
identified in the remdesivir at AsnA:142, SerA:144, CysA:145, HisA:163, GluA:166,
and GlnA:189, whereas two carbon–hydrogen bonds were formed by the residues
HisA:41 and MetA:165. Cepharanthine showed a better binding affinity toward Mpro
(–7.9 kcal/mol) than ascorbic acid (–5.4 kcal/mol). Four carbon–hydrogen bonds were
formed in the cepharanthine-Mpro complex at HisA:164, ProA;168, GlnA;189, and
ThrA:190.
Conclusion: The findings of this study propose that these drugs are potentially
inhibiting the SAR-CoV-2 virus by targeting the Mpro protein

Diagnostic Reference Levels in Mammography in the Asian Context

Chamudi Ishara Rajamuni — 2022-10-04

Background: Breast cancer is the most frequent cancer among the female population
globally. Therefore, early detection is helpful for effective treatments and to reduce
the mortality rate. Mammography is a radiological examination done with low-energy
X-rays to detect abnormalities in breast tissue. This study aims to review the literature
to evaluate the techniques, protocols, and conversion factors used to determine the
diagnostic reference levels (DRLs); within the Asian continent using both phantom- and
patient-based data.
Methods: Related articles were systematically reviewed via Pub Med, Google scholar,
and freehand search with the aid of relevant terms. Related abstracts in English were
screened, and suitable articles were selected after reviewing the full-text. Four hundred
and thirty abstracts were screened for relevance, and 12 articles were selected.
Results: The study comprises four phantom-based and eight patient-based studies.
The studies varied between the types of test subjects, conversion factors, breast
compression thickness, and dose calculation protocols. This obstructs continuing the
DRLs with the updates and comparisons among countries. Establishments of DRLs
in Asian countries are less than the rest of the world. DRLs should be measured
continuously, and should be updated based on other clinical parameters of the
patients.
Conclusion: DRLs in mammography were measured from time to time in different
geographical locations in Asia by following various techniques. But when compared
with the other regions of the world, there is less consideration for establishing DRLs in
Asia. There should be standard protocols and updated conversion factors according
to the advancements of the technology to ensure radiation protection with optimal
absorbed dose with appropriate image quality

Bilateral Sub-acute Subdural Hematoma of the Posterior Fossa As a Complication of Anti-coagulation Therapy: A Case Report and Literature Review

Moayad Ahmed — 2022-10-04

Background: Subdural hematomas are one of the commonest neurosurgical
pathologies faced in practice and it is rarely located in the posterior fossa. Posterior
fossa subdural hematomas are challenging because of the difficulty in their diagnosis
and management.
Case Presentation: A case of bilateral sub-acute subdural hematoma of the posterior
fossa in a 65-year-old female presented with a complaint of headache and vomiting
for three weeks followed by a decreased level of consciousness two days prior
to admission. The patient is a known cardiac patient on long-term anti-coagulant,
her condition was intensively investigated and the diagnosis of posterior fossa subacute hematoma was reached, following which the patient was treated surgically and
improved in the postoperative period.
Conclusion: Subdural hematomas located in posterior fossa are considered very rare.
Most of the reported cases are due to anti-coagulant use, with minor number of cases
due to trauma. Literature denoted difficulty reaching diagnosis using only computed
tomography and advice to be aided by magnetic resonance imaging as in our case. In
most occasions, surgical management is the best choice for the management of such
a case, regardless of surgical technique, and will result in excellent outcome.

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