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Background: Malaria is a severe disease, so delay in treatment could increase morbidity and mortality. World Health Organization recommends confirmation of the diagnosis by laboratory test before initiation of therapy. Smear microscopy and polymerase chain reaction are methods approved by WHO for diagnosing malaria, but they are time-consuming, operator-dependent, and require laboratory staff training. WHO has recommended the Blood-based Rapid Diagnostic Test (RDT) as an acceptable method for diagnosing malaria. It provides rapid results and can be performed with limited resources. Methods: Four hundred and fourteen febrile cases admitted to Khartoum North General Hospital, Khartoum, Sudan during January 2021 - June 2021 with clinical suspicion of malaria were examined for the presence of asexual forms of Plasmodium falciparum in peripheral blood smears. Blood smear microscopy-positive patients who matched the acceptance criteria were included, while negative patients were selected as control cases. Blood and urine samples were examined with the same RDT kits designed for blood. Results: Fifty-eight blood smear-positive cases and 50 febrile blood smear-negative cases were enrolled in the study. The sensitivity and specificity of urine-based RDT were 82.76% and 92.00%, respectively, while blood-based RDT was 96.55% and 96.00%. Conclusion: This study aimed to evaluate the performance of urine-based RDT through comparison with blood-based RDT and the use of blood smear microscopy as the reference method. Although the results showed acceptable performance of both tests, more extensive sample size studies should be conducted to consider urine samples as an alternative sample for diagnosing Plasmodium falciparum malaria.

Abstract Background Because of the subjective character of symptoms, absence of a diagnostic test, modest response to treatments, and, at times, patient reports of important functional disability, fibromyalgia remains a challenge for the treating health care professionals in the standard clinical practice. The aim of this study was to develop an up-to-date consensus and evidence-based clinical practice guidelines for a treat-to-target management of fibromyalgia. Fifteen key clinical questions were identified by a scientific committee according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. A literature review team performed a systematic review to summarize the evidence advocating the benefits and harms of available pharmacologic and nonpharmacologic therapies for fibromyalgia. Subsequently, recommendations were formulated. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A 3-round Delphi process was conducted with 16 experts. All rounds were conducted online. A consensus was achieved on the direction and the strength of the recommendations. Results An online questionnaire was sent to an expert panel who participated in the three rounds (response rate 100%). At the end of round 3, a total of fifteen recommendation items, categorized into 10 sections to address the main fibromyalgia categories, were obtained. Agreement with the recommendations (ranks 7–9) ranged from 85 to 100%. Consensus was reached (i.e., ≥ 80% of respondents strongly agreed or agreed) on the wording of all the 15 clinical standards identified by the scientific committee. An algorithm for the management of fibromyalgia has been suggested. Conclusions These recommendations provide an updated consensus on both the non-pharmacological and the pharmacological treatments of fibromyalgia. The provided strategies to reach optimal treat-to-target outcomes in common clinical scenarios are based on a combination of evidence and expert opinions. Best treatment decisions should be tailored to each individual patient situation.