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Background: Limited published data exist on the association between parity (number of deliveries) and diabetes mellitus (DM). This study was conducted to evaluate the association between parity and type 2 DM (T2DM) among Sudanese women. Method: A multistage sampling survey was conducted in four villages in the River Nile State, Sudan, between July and September 2022. The World Health Organization's three-level stepwise questionnaire was adopted to collect women's sociodemographic characteristics (age, sex, height, weight, marital status, parity, education level, occupation, detailed obstetric history, and family history of T2DM). Multivariate analyses were performed. Results: A total of 397 women were recruited. Their median (interquartile range) age was 45.0 (33.0‒55.7) years. A total of 154 women (38.8%) were nulliparous, whereas 93 (23.4%), 70 (17.6%), and 80 (20.2%) had para 1‒3, 4 or 5, and more than 5, respectively. A total of 112 (28.2%) women had T2DM. In multivariate analysis, older age (adjusted odds ratio, AOR, 1.04, 95%, confidence interval, CI, 1.02‒1.06), high parity (AOR, 1.1, 95% C, 1.01‒1.20), and a family history of DM (AOR, 3.26, 95% CI, 1.98‒5.38) were associated with T2DM. Compared with the nulliparity, para 1‒3 (AOR, 2.33; 95% CI, 1.17‒4.61), para 4 or 5 (AOR, 2.12; 95% CI, 1.04‒4.30), and para > 5 (AOR, 2.16; 95% CI, 1.09‒4.27) were at higher risk of T2DM. In women aged < 50 years, high parity (AOR, 1.22; 95% CI, 1.06‒1.44) was associated with T2DM. Compared with the nulliparous women, para 4 or 5 (AOR, 3.47; 95% CI, 1.16‒10.34) and para > 5 (AOR, 4.63; 95% CI, 1.54‒13.87) were associated with T2DM, whereas para 1‒3 was not associated with T2DM. In the women aged ≥ 50 years, parity and parity groups were not associated with T2DM. Conclusion: There is a high prevalence of T2DM among Sudanese women. Parity and high parity are significant predictors of T2DM among these women in this part of Sudan. [ABSTRACT FROM AUTHOR]

Background: War results in widespread destruction of a country's infrastructure, healthcare facilities, and educational institutions. This study aims to assess the attacks on medical schools amidst the ongoing conflict in Sudan. Methods: A descriptive cross-sectional study was conducted across 58 medical schools located in the states of Khartoum, Darfur, and Kordofan. Data on attacks between April 15, 2023, and July 15th 2023, were collected using online data collection form. Results: All medical schools in conflict areas were included in the study. More than half (58.6%) of these medical schools were attacked. Private schools, constituting the majority of the study sample, were the most frequently attacked (70.6%). Of these, 52.9% were located in Khartoum city. More than one form of attack was reported in 64.7% of the affected schools. Looting occurred in 73.5% of the attacked faculties, while 67.6% of them were converted into military bases. Despite these challenges, 60.3% of the schools in the conflict zone managed to restore the educational process through online learning and collaboration with other institutions. Conclusion: During a three-month period of warfare, most medical schools within conflict zones were attacked. This emphasizes the vulnerability of medical education institutions during war and highlights the urgent need of the Ministry of Higher Education interventions to provide leadership, support, and oversight for the educational process in medical schools across the country. [ABSTRACT FROM AUTHOR]

Background: Adequate training in infectious diseases and antibiotic resistance is crucial for pharmacy students to participate in antibiotic stewardship programs and understand microbiology careers. Aim: The study was carried out to assess the knowledge and self-reported confidence in antibiotic resistance, antibiotic therapy, and antimicrobial stewardship (AMS) among final-year undergraduate pharmacy students in Sudan. Methods: A cross-sectional study was conducted in three universities using a 57-item online questionnaire between April and May 2022. Results: A total of 109 students (response rate 36%) participated and showed average knowledge scores of 5.6± 1.7 (out of 10.0) for antibiotic resistance, 4.9± 2.0 (out of 5.0) for appropriate antibiotic therapy, and 3.1± 1.4 (out of 5.0) for AMS. No significant differences were observed among schools. Some students reported poor knowledge about antibiotic therapy and the consequences of resistance. One-third of students lacked confidence in interpreting microbiological results. Knowledge of antibiotic resistance among students' practice area after graduation was higher (p=0.017) and those interested in ID careers (5.8 vs 4.8) (p=0.037). Male students (5.6 vs 4.5) and those interested in ID careers (4.3 vs 3.4) (p< 0.001) had higher scores of appropriate antibiotic therapy. Students attended antibiotic resistance courses (51.5 vs 45.2), and those interested in ID significantly had higher self-confidence (55.3 vs 45.8) (p=0.008). Conclusion: Pharmacy students in Sudan have substantial knowledge of AMS and antibiotic resistance with poor knowledge of antibiotic therapy. Adequate training about infectious diseases and related topics is recommended to improve pharmacy students' understanding of microbiological findings, other competencies, and skills to incorporate in antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

This study assesses the prevalence and determinants of inadequate (less than eight contacts) and late antenatal care (ANC) initiation (starting after 12 weeks) among mothers delivered at Gadarif Maternity Hospital in eastern Sudan. A hospital-based cross-sectional study was conducted at Gadarif Maternity Hospital. A questionnaire was used to collect sociodemographic, clinical, and obstetric data through face-to-face interviews. Seven hundred mothers were enrolled with the median (interquartile range) of mothers' age, and parity was 28(24–32) years and 3(2–5), respectively. Of these 700 mothers, 79.3 percent and 10.3 percent had inadequate and late ANC, respectively. In multivariable logistic regression analysis, being a housewife (adjusted odds ratio [AOR] 1.93, 95 percent CI 1.09, 3.43) was associated with inadequate ANC. High parity (AOR 1.27, 95 percent CI 1.07–1.52) was positively associated with late ANC initiation. There was no association between age, residence, education, preexisting medical disorder, and history of miscarriage) with inadequate or late ANC initiation In eastern Sudan, four out of five mothers did not comply with the World Health Organization's recommendation of a minimum of eight ANC contacts for positive pregnancy outcomes. This study is crucial for policy-makers to take further strategic actions to ensure adequate and early ANC initiation for all mothers in Sudan. [ABSTRACT FROM AUTHOR]

Introduction: Asthma is a serious disease that affects not only the respiratory system but also the brain by decreasing oxygen saturation. Despite the numerous neuroimaging studies that have shed light on the effect of asthma on brain volume, there is still a need for new studies to evaluate brain volume in asthmatic patients. Aim: To evaluate the Grey Matter Volume (GMV) of the brain in asthmatic patients using Magnetic Resonance Imaging (MRI) images to detect possible changes. Materials and Methods: This is an observational analytic casecontrol study carried out at Al Amal Hospital in Khartoum State, Sudan, between January 2020 and October 2022. The study included 100 adult participants (50 asthmatic patients and 50 healthy controls) using MRI and automatic brain segmentation through a software program (BrainSuite). Data were analysed using Statistical Package for Social Science (SPSS) software, version 25.0 (IBM SPSS Inc., Chicago, IL), and Microsoft Excel 2013. An independent sample T-test was used to compare the mean of the measurements between controls and asthmatics. Frequencies, means, and standard deviations were taken. A p-value of 0.05 or less was accepted as statistically significant. Results: Out of all participants, 50 were asthmatics and 50 were controls. The mean age of asthmatics was (31±8.53) years and of controls was 32 ± 8.49 years. The mean Grey Matter Volume (GMV) of the asthmatic patients was 575.93 cm³ ±71.46 SD and of controls was 569.55 cm³ ±73.77 SD. There were no statistically significant differences between the groups depending on the GMV of asthmatic and control participants (p>0.05). The mean GMV in asthmatic males was 355.50 cm³ ±53.26 SD and in females 321.65 cm³ ±32.72 SD, while in control males it was 367.63 cm³ ±45.77 SD and in females 318.03 cm³ ±34.16 SD. GMV showed significant statistical differences between asthmatic males and females (p<0.05). Conclusion: There were no statistically significant differences between the groups depending on the GMV of asthmatic and control participants (p>0.05). Asthma disease does not result in noticeable changes in GMV in either male or female brains. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease with devastating, disabling, and negative impacts on the patients' quality of life (QoL). Although MS was not known in Sudan, it seems to be rising in recent years. This is a cross-sectional, hospital-based study aimed at assessing the impact of MS medications on patients' QoL in neurology clinics in Khartoum City. Sixty-four patients diagnosed with MS were recruited. SF-36 questionnaire was used to assess the patients' QoL. Data were collected from patients' records in addition to the hand-delivered questionnaire. Data were analyzed using ANOVA test and logistic regression; p ≤ 0.05 was considered statistically significant. Results: The majority of patients were females from north Sudan (92.2%). The mean age was 28.2 ± 6.5. Relapsing–remitting was the most diagnosed MS type (65.6%). Fatigue and urinary incontinence were the most observed symptoms. All patients had vitamin D deficiency (5–20 ng/ml). Disease-modifying therapies (DMTs) were prescribed to 37.5% of patients. The overall mean QoL was 53.9 ± 14.7 with fair physical and mental health (51.8 ± 19.2 and 57.0 ± 10.9, respectively). Patients on DMTs showed a significantly good QoL compared to azathioprine (p ≤ 0.01), corticosteroids (p ≤ 0.01.), and no medications (p ≤ 001). Azathioprine (OR = 0.12; p ≤ 0.05), corticosteroids (OR = 0.14; p ≤ 0.05) and no treatment (OR = 0.01; p ≤ 0.001) negatively affected MS patients' QoL when compared to DMTs. Vitamin D supplementation was significantly (p ≤ 0.01) associated with good QoL. Conclusions: MS was prominent in young females' descendants of Sudanese northern tribes. DMTs improve the devastating effect of MS on patients' QoL, and vitamin D supplementation was significantly associated with good QoL of MS patients. [ABSTRACT FROM AUTHOR]

Background: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023. Methods: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done. Result: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS. Conclusion: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus is a major noncommunicable disease worldwide, and its prevalence is rapidly increasing. The Finish score helps in the prediction of the risk of future diabetes development, as well as in the identification of undiagnosed diabetes. The current study was conducted to identify people at risk of developing type II diabetes mellitus in River Nile State, Sudan. Methods: This cross-sectional community-based study was conducted in River Nile state between 2019 October and 2020 March. Data were collected using a questionnaire that included the Finnish Diabetes Risk Score variables from 400 participants after an informed consent. Chi-square test was used to test the associations, with the P-value considered significant when <0.05. Results: The majority of participants (257 [64.3%]) were <45 years old, and 229 (57.3%) were male. The risk of type II diabetes mellitus was found to be low in 187 (46.8%) people and high in 213 (53.2%). Moreover, 128 (32%) had a body mass index (BMI) between 25and 30 kg/m², while 46 (11.5%) had >30 kg/m² . Waist circumference of <94 cm was found in 147 (36.8%) males, while only 63 females (15.8%) had a waist circumference <80 cm. Age, gender, BMI, daily activity, history of hypertension, history of hyperglycemia, and family history of diabetes were all significantly associated with the risk of developing diabetes mellitus (P < 0.001). Conclusion: The Finnish Diabetes Risk Score was found to be useful in facilitating wider access to the risk of type II diabetes among the study population. More than half of the study population were at risk of developing diabetes mellitus. [ABSTRACT FROM AUTHOR]

Visceral leishmaniasis (VL, kala azar), caused by Leishmania donovani, transmitted by Phlebotomus orientalis, is a serious systemic disease that causes high morbidity and mortality rates in Sudan and other parts of East Africa and the world. Despite progress in understanding the epidemiology of the disease in East Africa, little is known about the host preference of P. orientalis in kala azar endemic villages of Sudan, which have some of the highest VL incidence rates in the world. The present study used host choice experiments and blood‐meal identification approaches to determine the host preference of P. orientalis in kala azar endemic villages in Gedarif state, eastern Sudan. In the host choice experiment, tent traps were used to compare the attractiveness of cows, donkeys, sheep and goats for host‐seeking P. orientalis. In the blood‐meal identification study, blood‐fed P. orientalis females, captured inside houses and peri‐domestic habitats, were subjected to molecular typing using cytochrome b gene (cyt b) amplification and sequence analysis. Cows and donkeys were the most attractive to blood‐seeking P. orientalis, followed by goats. Similarly, the blood‐meal analysis of P. orientalis showed that the vector preferentially feeds on cows, followed by donkeys, humans and goats. The human blood index of P. orientalis was 19.4% (42/216), indicating a high zoophilic habit of the vector, both inside and outside the houses. Although the order of host preference varied by location, it was clear that cows are the most preferred host of P. orientalis in the area. Results are discussed in relation to the role of domestic/livestock animals in VL zoopotentiation and zooprophylaxis. Inference is made on the potential impact of insecticide treatment of cows in control of the vector and the transmission of VL in Sudan and other parts of East Africa. [ABSTRACT FROM AUTHOR]

Reproduction is among the most vital biological processes in the life cycle of any organism, such as fish. The biology of Oreochromis niloticus reproduction in Lake Nasser and Lake Nubia was studied using different mesh sizes of gill nets. A total of 480 Oreochromis niloticus were caught from Lake Nasser, Egypt, and 369 from Lake Nubia, Sudan, from January through December 2021. Sex ratio size at first maturity and maturity stages of O. niloticus were examined. In Nasser's Lake, the sex ratio of male to female was 1:1.02, whereas in Lake Nubia, it was 1:0.89. The first maturity length in Lake Nasser was 27.5cm for males and 27cm for females, while in Lake Nubia, it was 32cm for males and 26cm for females. The gonado somatic index indicated that the species breeds in Lake Nasser and Nubia during summer and spring, respectively. [ABSTRACT FROM AUTHOR]

This study investigated the link between angiotensin I-converting enzyme insertion/deletion (ACE I/D) polymorphism and unexplained spontaneous abortion. This retrospective analytical case-control was conducted at the Omdurman Maternity Hospital in Sudan. The current study contained 230 individuals, including 119 cases (women who had at least three abortions) of unknown cause and 119 controls (healthy women who had at least two full-term deliveries without spontaneous abortion). Patients and controls were provided five ml of ethylenediaminetetraacetic acid blood and answered questionnaires about their demographics, personal lives, and family histories. ACE I/D polymorphisms were assessed using a conventional polymerase chain reaction approach after total genomic DNA was isolated from blood leukocytes using the GF-1 blood DNA extraction kit. Data was analyzed using the Statistical Package for the Social Sciences version 24. ACE I/D polymorphism is strongly linked to unexplained spontaneous abortion, and women with the I/D and D/D genotypes are more likely to have it than those with the I/I genotype. The current study reveals that ACEI/D polymorphism increases pregnancy problems. Sudanese women may have spontaneous abortions due to the ACE I/D polymorphism. [ABSTRACT FROM AUTHOR]

Background: Headache disorder is the second-highest cause of disability worldwide; however, data are scarce on headache among adolescents, especially in Africa. There has yet to be published data on headache among adolescents in Sudan, the third-largest country in Africa. This study aimed to assess the prevalence of primary headache disorders and associated factors among adolescents (10–19  years) in eastern Sudan. Methods: A community-based cross-sectional study was conducted in the city of Gadarif in eastern Sudan. Questionnaires were used to gather the adolescents’ sociodemographic characteristics. Headache diagnostic questions were based on the beta version of the International Classification of Headache Disorders-III (ICHD-3). Multivariate analysis was conducted to assess the associated factors for primary headache disorders, and the results were expressed as risk ratios (RRs) and 95.0% confidence interval (CI). Results: Of the 401 enrolled adolescents, 186 (46.4%) and 215 (53.6%) were male and female, respectively. The median (IQR) age was 14.0 (12.1–16.2) years. Eightyone (20.2%) of the 401 adolescents reported experiencing primary headache disorders, including migraine with aura in 16 (4.0%), migraine without aura in 33 (8.2%), tension-type in 14 (3.5%), and undifferentiated headache in 18 (4.5%) adolescents. The prevalence of primary headache disorders was significantly higher in females than in males [55/215 (67.9%) vs. 26/186 (32.1%), p  =  0.004]. In the multivariate analysis, increased age (RR =  1.09, 95.0 CI =  1.02–1.16) and being female (RR =  1.75, 95.0 CI =  1.14–2.67) were associated with increased RR of primary headache disorders. Parents’ education level and occupation, smoking/snuff use, and body mass index were not associated with primary headache disorders. Conclusion: One-fifth of the adolescents in eastern Sudan reported experiencing primary headache disorders, which was more common in females and with increased age. [ABSTRACT FROM AUTHOR]

Background: Malaria is considered the most deadly and difficult parasitic disease in the world. This study aims to use Markov chains to predict the probability patterns of stability or change in malaria incidence and deaths. Methods: Markov chains were used to analyze the data on malaria incidence and deaths through the Windows Quantitative Systems for Business (WINQSB) program. Data was obtained from the Ministry of Health, Gazira State, Health Information Centre, Sudan. The data is a time series, from 2001 to 2021 per year, according to three cases of decrease, stability, and increase. A transitional matrix is built for the three cases. Results: The results revealed that the probability that malaria incidence and deaths will reach a stable state in one year and in the long run; the probability of transitioning to an increased state was 0.66 of malaria incidence; and the probability of moving to a decreased state was 0.52 of malaria deaths. Conclusion: The results show that the malaria incidence will increase and malaria deaths will decrease in the short and long run from 2022 to 2030 in Gazira State. It is necessary to reinforce means and resources for case management and to investigate the determinants of the situation. Thus, strategies are urgently needed to arrest the unacceptably high incidence and death rates. [ABSTRACT FROM AUTHOR]

The rate of chronic kidney diseases (CKD) is increasing steadily in Sudan, and hypertension remains one of the most common coexisting conditions among the patients. In this meta-analysis, we aimed to answer the review question (what is the prevalence of hypertension among patients with advanced CKD in Sudan?). We applied a guidelines checklist for the literature search about the (PRISMA-P 2015). We searched Google Scholar, PubMed, Cochrane Library, Embase, and Medline electronic databases for all articles on CKD conducted in Sudan. Eventually, we identified 23 studies, and only eight were included in the final meta-analysis. Out of the eight articles, there is a total sample of 2682 patients who were presented and diagnosed with advanced stage CKD; among them, 864 were found to be hypertensive, and the overall pooled prevalent rate of hypertension was 32% (95% CI 25% to 39%) with 91% heterogeneity. The lowest rate of hypertension among patients diagnosed with CKD was falling in the range of (14%-21%). We assessed the heterogeneity among studies using the I2, T2, and Q statistics. The results showed a funnel plot with asymmetrical distribution for effect sizes. The literature and evidence-based data on CKD in Sudan are scarce. However, the eight studies reviewed revealed elevated odds of CKD among patients with hypertension. The burden of the increased rate of CKD associated with prevalent hypertension and DM is a call for authorities for urgent interventional response. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate job satisfaction among veterinarians working in the private sector in Khartoum State, Sudan. A structured questionnaire tool with a 5 Likert scale was used. It is distributed to a population sample of 157 veterinarians. Responses to the demographic section showed almost equal numbers of males and females among the respondent vets. Most of those respondents were from north (59%). The average monthly salary of all the respondent vets in the sample population was less than 344$ with the majority (80.9%) under 40 years of age. The analysis revealed a significant association between some of the dependent factors in the study while there is a statistical difference in gender responses to some of the factors of Job facilities and Career development. The general direction of samples in Career development was found to be towards “Agree” while the general direction of the samples in both sections of Job facilities and Job satisfaction was found to be towards “Neutral”. Veterinarians working in the private sector in Khartoum State are partially satisfied with their jobs. Awareness of job satisfaction and interaction between the veterinary community and veterinary institutions are needed to meet the sector needs in the final product (veterinarians) and to raise the confidence of the veterinarian in the job market. [ABSTRACT FROM AUTHOR]

Infectious bursal disease (IBD) is a severe, highly contagious immunosuppressive disease. This study aimed to investigate a suspected Infectious bursal disease field infection with apparent morbidity and elevated mortality in a floor-reared Hy-line layer flock in Khartoum State, Sudan. The investigated flock showed depression, dullness, ruffled feathers, diarrhea, pasted vent, and decreased feed and water intake. The affected birds were underweight (800gm to 870gm). The mortality rate was found to be 14.7%. A post-mortem examination revealed enlarged, edematous bursae with various degrees of petechial hemorrhage in the serosal and mucosal surfaces. Hyperemia, inflammation, yellowish exudate, and atrophy were also seen in some of the affected bursae. Extremely distended ureters filled with a whitish material were detected. Enlarged kidneys with degenerative changes and obvious necrotic foci were detected grossly. Agar Gel Immuno-diffusion (AGID) tests and inoculation of the virus in chick embryos were found to be negative. Indirect IBD conventional ELISA test for VP3 for serum of 20 birds revealed 100% positive cases. Creatinine, uric acid, and urea in the serum of 22 infected birds from the diseased flock and 19 noninfected birds from the original flock showed a recognizable elevation in the three parameters that reached about 5 times, 6 times, and 2 times respectively. The presence of bursae with obvious lesions in a layer flock of 21 weeks of age was considered the main criterion for the diagnosis. The flock was diagnosed with IBD. ELISA results support the diagnosis. Infection with IBD at this age (21 weeks) could be attributed to bad management in general and bad nutrition in specific which led to being underweight and delayed the regression and disappearance of the bursa of Fabrecious. [ABSTRACT FROM AUTHOR]

Background: Floods are the most frequent natural disasters with a significant share of their mortality. Preparedness is capable of decreasing the mortality of floods by at least 50%. This paper aims to present the psychometric properties of a scale developed to evaluate the behavior of preparedness to floods in Sudan and similar settings. Methods: In this methodological scale development study, experts assessed the content validity of the items of the developed scale. Data were collected from key persons of 413 households living in neighborhoods affected by the 2018 floods in Kassala City in Sudan. A pre-tested questionnaire of sociodemographic data and the Flood Preparedness Behavior Scale (FPBS) were distributed to the participants' houses and recollected. Construct validity of the scale was checked using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency of the scale was checked using Cronbach's alpha. Test-retest reliability was assessed by Pearson's correlation coefficient. Item analyses and tests of significance of the difference in the mean scores of the highest and lowest score groups were carried out to ensure discriminatory power of the scale items. Results: Experts agreed on the scale items. Construct validity of the scale was achieved using EFA by removing 34 items and retaining 25 items that were structured in three factors, named as: measures to be done before, during, and after a flood. Confirmatory factor analysis confirmed the construct obtained by EFA. The loadings of the items on their factors in both EFA and CFA were all > 0.3 with significant associations and acceptable fit indices obtained from CFA. The three factors were found to be reliable in terms of internal consistency (Cronbach's alpha coefficients for all factors were > 0.7) and test-retest reliability coefficient. In item analysis, the corrected total item correlations for all the items were > 0.3, and significant differences in the means of the highest and lowest score groups indicated good item discrimination power. Conclusion: The developed 25 items scale is an instrument which produces valid and reliable measures of preparedness behavior for floods in Sudan and similar settings. [ABSTRACT FROM AUTHOR]

Desert locust (Schistocerca gregaria) infestations cause significant damage to crops and pastureland, impeding food security and livelihoods globally. In recent years, some East African countries have suffered severe desert locust outbreaks, causing significant harm to agriculture and local communities. To comprehensively understand and mitigate the socio‐economic impacts of this pest, an integrated assessment approach is crucial. This study proposes an integrated assessment model that combines ecological, economic, and social dimensions to analyze the multifaceted impacts of the desert locust on the rate of urbanization changes, farming expansion, and food production and how they lead to food unavailability (demand, supply, and price) and food and nutrition insecurity in Eastern Africa. A system dynamics‐based assessment model was first developed for Sudan using the dynamic relations among the factors and their variations over time and how they affect the socio‐economic variables. The developed model was used to spatially simulate the impacts over the entire Eastern Africa. Various scenarios were further simulated and analyzed, incorporating different policy options to effectively mitigate the impacts. Results demonstrated that in all the countries, desert locusts extensively contribute to the slowing down of farming expansion and food production and supply. Consequently, these factors lead to increased urbanization rates through people rural‐urban migration and food demand at different magnitudes across different countries. By considering both short‐term and long‐term effects, this approach aims to provide policymakers, researchers, and practitioners with a holistic understanding of the complex dynamics involved and inform effective management strategies. For example, communities equipped with accurate breeding detection tools and employing an integrated pest management strategy combining chemical pesticides and biopesticides had the highest potential for effectively mitigating the future impacts of desert locusts for enhancing community livelihood. Plain Language Summary: Desert locusts are a major problem for agriculture and communities in East Africa. They eat crops and grasslands, which can lead to food shortages and higher prices. To better understand and deal with this issue, we have created a model that looks at how locusts affect things like farming, urbanization, and food supply. We studied this in Sudan and then applied it to the whole of East Africa. The results showed that locusts make farming harder and push more people to move from rural areas to cities. This causes more demand for food in cities. The study tested different ways to deal with locusts and found that communities with good tools for detecting locusts and using both chemical and biopesticide control methods were the best at reducing the impact of locusts on their lives. This study gives policymakers and others a better understanding of how locusts affect communities and how to manage them effectively in the future. Key Points: In Eastern Africa, desert locusts swarm in vast numbers, devouring crops, and vegetation, causing crop production losses ranging from 42% to 69%The system dynamics model was employed for a comprehensive analysis of the impacts, scenarios, and policy options for mitigating desert locust effectsDesert locusts hinder farming, reduce food production, spur urbanization, and heighten food insecurity across affected Eastern African countries [ABSTRACT FROM AUTHOR]

Background: The development of the nursing profession depends significantly on how communities perceive it. This study aims to identify the views and attitudes of Arabic communities, specifically those in Sudan, Yemen, and Egypt, toward the nursing profession. Methods: A descriptive comparative study was used to identify the perception of Arabic communities (Sudan, Yemen, and Egypt) toward the nursing profession. The study was conducted in three Arabic countries (Sudan, Yemen, and Egypt) using an online approach by sending the link of questions to the targeted population using emails, WhatsApp, and social media. There were 529 participants from the three Arabic countries. The study was analyzed by SPSS software using descriptive and inferential statistics. Results: A majority (75.6%) of the participants were aged <40 years, with most (82.9%) being between 21 and 30 years of age. There was a generally positive perception toward the nursing profession among these communities: 97.6% of Sudanese, 94.9% of Yemenis, and 96.1% Egyptian. There was a borderline statistical significance between the Sudanese and Egyptians' age and their perception toward their profession. Gender is the only factor influencing the perception in Sudan and Egypt, and while women have a higher positive perception in Egypt, men have a higher positive perception in Sudan. Conclusion: Overall, the perception of Sudanese, Yemeni, and Egyptian communities toward the nursing profession is acceptable. The only influencing factor on the level of perception was Egyptian females who have high positive perception toward the nursing profession and Sudanese males who have high positive perception toward nursing profession We recommend further research to assess the perception toward nursing from different sociocultural backgrounds and on a larger sample size. [ABSTRACT FROM AUTHOR]

Background: Pain is globally prevalent, affecting quality of life and driving most people to seek medical care. Nurses are essential for pain assessment and treatment. Adequate nursing awareness, attitudes, and skills are vital for optimal management. This study investigates nurses' awareness and practice toward pain assessment and management as the fifth vital sign in Sudan. Methods: This study was a cross-sectional, hospital-based study. Convenience sampling was performed to collect information from nurses working at four government hospitals using a self-administered questionnaire 24 November 2020 and 18 April 2021. The study utilized descriptive and inferential statistics for data analysis. Results: A total of 393 registered nurses participated in this study. Most (66.7%) were women, 46.6% were aged 20-25 years, and 69.2% had a bachelor degree. More than half of the nurses had low awareness of pain assessment (51.7%) and management practices (53.7%). A weak positive correlation was observed between awareness and practice (r = 0.280, P = 0.000). Women nurses showed a higher awareness (204.80, P = 0.048). Nurses with a high level of education showed higher awareness (249.32, P = 0.031) and higher practice (272.00, P = 0.029). Nurses working in the critical care unit performed significantly better than others (234.61, P = 0.001). Conclusion: There is a low level of awareness regarding pain assessment and management practices. This study suggests the need for more research and training programs, especially for nurses with low educational levels. [ABSTRACT FROM AUTHOR]

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Acetylcholinesterase enzyme (AChE) activity is impaired by a variety of inhibitors including organophosphorus pesticides, leading to the accumulation of acetylcholine. In this study, we aimed to determine the association between cancer and the blood level of the (AChE). This is a multicenter hospital-based case–control study conducted in the Radiation and Isotopes Center Khartoum, and Institute of Nuclear Medicine and Molecular Biology and Oncology Gezira. One hundred and fifty participants, half of them cancer patients and half cancer free were recruited. All participants were screened for demographic, environmental, occupational, and clinical characteristics. Blood for the (AChE) activity test was drawn from participants in the two groups. The mean age of the participants was 40.6 ± 14.8 years. Geographical distribution showed the Central Region of Sudan had the highest rate of cancer, followed by North State, Khartoum State, West State, and East State. The most common tumor subtype was breast cancer, followed by leukemia, colon, esophageal, and prostate cancer. Inferential analysis revealed significantly impaired (AChE) activity among cancer patients compared to controls (53.4 ± 20.3% vs. 93.8 ± 8.8, p-value 0.001). There was a significant statistical association between impaired (AChE) activity and cancer. (AChE) activity might be applied in the future as a diagnostic biomarker and therapeutic target. Further large sample and molecular studies are recommended. [ABSTRACT FROM AUTHOR]

Background: The nomadic camels herders utilizing the extensive production system in Sudan depend mainly on fermented milk, locally known as Gariss, as their main stable food for several months during the year. Methods: This study was conducted to assess some factors (locations, types of containers used for preparing Gariss and camels watering intervals) affecting the compositional content of Gariss that is commonly prepared by nomadic camel herders. Gariss samples (n-118) were collected during February 2018, from nomadic herders in 4 locations in Al-Koma Locality, North Darfur State, Sudan. Results and discussion: The chemical analysis conducted during this study indicated that the mean levels of the total solids, fat, protein and ash content and the pH values of Gariss samples revealed 7.35 ± 0.22%, 2.58 ± 0.08%, 1.86 ± 0.04% and 0.67 ± 0.01% and 3.77 ± 0.03, respectively. The data showed that Gariss prepared in Siin showed the highest total solids (7.7 ± 0.71%), protein (2.02 ± 0.18%), fat (2.60 ± 0.19%) and ash (0.68 ± 0.04%) content, while it revealed the lowest pH value (3.61 ± 0.11). Gariss prepared in plastic containers showed the lowest total solids (7.30 ± 0.23%) and protein (1.48 ± 0.28%). Moreover, Gariss from milk of camels that drink water every 14 days revealed high values for total solids (7.91 ± 0.29%), fat (2.80 ± 0.11%), protein (1.99 ± 0.05%) and pH (3.78 ± 0.04), while it showed the lowest ash (0.67 ± 0.02%) content compared to those made from milk of camels with drinking water frequency of 10 days. Conclusion: The study concluded that the compositional content of Gariss was affected by the frequency of water drinking by camels in addition to the containers used for its preparation; as the compositional content of Gariss from Siin showed the best values followed by that stored in Bokhsa. Thus, the study recommends that Siin and Bokhsa should be considered as valuable ethnic containers in keeping camel fermented milk with better compositional content. [ABSTRACT FROM AUTHOR]

Background: Intensive Care Unit (ICU) is a specialized ward where critically ill patients are admitted to provide intensive health care Inappropriate antimicrobial therapy (AMT) and high mortality rates were documented in the ICU. The influence of irrational use of empiric antibiotics on clinical outcomes in ICU patients is not well studied in Sudan.Aim: This study aims to determine the rational use of antibiotics and its impact on clinical outcomes among ICU patients.Methods: Using data collection form, a retrospective longitudinal study was conducted among ICU patients at Omdurman Military Hospital, Khartoum State. Patients admitted from January 2019 to December 2019 were included in the study. Patients who stayed in ICU < 48 hr were excluded. Appropriateness of AMT is assessed using culture sensitivity test (CST) and the American Society of Infectious Diseases (IDSA) guideline.Results: Among 102 patients, 54.9% male, one-third of patients developed nosocomial infections, 80.4% received empiric therapy with broad-spectrum antibiotics. The CST is done in 19%, and 43% patients are prescribed inappropriate AMT. Inappropriate AMT is associated with recurrent infections 38.4% (p=0.028) and high mortality 33.8% (p=0.014). Overall mortality rate 63.7% ICU patients. Elevated mortality in nosocomial 57.8%, decreased with inappropriate AMT in 21.6% patients. Significantly higher mortality rates 90.7% among uncontrolled infections (p< 0.001), 80.6% nosocomial infections (p=0.001), and 76.7% renal compromised (p=0.002).Conclusion: Empirical AMT reduces the frequency of nosocomial infections, which has an impact on mortality. Inappropriate AMT is significantly associated with uncontrolled infections and lower mortality. Implementing a restrictive infectious control system and effective stewardship programs in hospital ICU wards is recommended. [ABSTRACT FROM AUTHOR]

Treatment failure of Artemether-Lumefantrine drug in treating uncomplicated malaria is increasing in many endemic malaria countries. Tolerance, recrudescence, and resistance of plasmodium falciparum and plasmodium vivax parasites to the drug are increasing all over the world. We aimed to measure the treatment failure of antimalarial Artemether-Lumefantrine (Coartem) and it is contributing factors in uncomplicated malaria among adults in health centers. This study was a descriptive cross-sectional health-facility-based study conducted from the first of April to the end of June 2022 and included 166 malaria patients with positive test results for malaria visited health centers. 9.6% of malaria patients were not responding to coartem, 6.0% of them were plasmodium falciparum, 2.4% were plasmodium vivax, and 1.2 were mixed infections. Thirty-one percent of those not taking the drug with the fatty meal tested positive for malaria after two weeks of receiving coartem, and 25% of those not adherent to the treatment timetable have not cleared the parasite despite receiving coartem. The results showed that nearly one-third of the patients received Coartem without laboratory tests for malaria. Artemether-Lumefantrine is becoming less effective in the treatment of uncomplicated malaria among adults in Khartoum state, Sudan. Prospective studies are needed to assess the frequency of treatment failure and the contributing factors that assist in decreasing drug efficacy. We also encourage pharmacists not to give antimalarial treatment without a medical prescription and a positive test. [ABSTRACT FROM AUTHOR]

Background: The Advanced Life Support in Obstetrics (ALSO) course is a globally recognized interprofessional training program designed to assist healthcare professionals in acquiring and sustaining the necessary knowledge and skills to handle obstetric emergencies effectively. This survey aimed to assess the use, barriers, and confidence in using the ALSO course guidelines in managing obstetric emergencies in Sudan. Methods: This descriptive cross-sectional study involved 103 physicians from the Sudan ALSO group in Sudan. A structured, close-ended questionnaire was distributed electronically to the participants. Data analysis was conducted using Statistical Package of Social Sciences Software version 26. Results: More than half of the participants were specialists (54.4%). Although all respondents claimed to adhere to the ALSO guidelines for managing shoulder dystocia, a lower percentage followed them for neonatal resuscitation (75.0%) and maternal venous thrombosis management (68.9%). Only 62.1% of participants felt confident performing neonatal resuscitation. The main barriers to implementing the ALSO course guidelines were the respondents' preference for other guidelines and their belief that the guidelines were not applicable in their specific settings. Conclusion: The majority of participants displayed a high level of confidence, indicating a positive perception of the guide's effectiveness. However, there is room for improvement, particularly in areas such as neonatal resuscitation and forceps-assisted births, where confidence levels were lower. Addressing barriers, including the preference for other guidelines and the applicability of the guide in specific settings, is crucial to ensure widespread adoption. Refresher training programs, contextual adaptations, and the integration of guidelines may help overcome these barriers and enhance the overall implementation of the ALSO guide in managing obstetric emergencies in Sudan. [ABSTRACT FROM AUTHOR]

Background: Female Genital Mutilation (FGM) is defined as any procedure that involves damage to the female external genitalia. This practice is majorly prevalent in Sudan, as it is estimated that over 12 million Sudanese women are circumcised. This study uncovers rural females' knowledge and insights about FGM domestically. Methods: A qualitative, deductive study with thematic analysis was conducted. A total of 42 female high school students were recruited and divided into five focus groups, each of which included girls from four different high school classes in the main school of the study area. A topic guide was prepared and used to lead the focus groups. Thematic analysis was used, and the study data had been categorized into four themes: knowledge, procedure and performance, experience, and practice. The condensed meaning units of each theme were identified, then classified to formulate sub-themes. Results: All the participants indicated that FGM is a traditional practice in the village. The vast majority have heard about it from family members, mainly mothers and grandmothers. Regarding the procedure, all the participants agreed that midwives perform FGM, but most of them don't know what exactly is being removed. According to all participants, mothers and grandmothers are the decision-makers for FGM. The majority of the participants stated that they do not discriminate between the circumcised and uncircumcised women and most of them agreed that circumcision has negative side effects. They have mentioned pain, difficult urination, and walking as early side effects, while psychological impacts and labor obstruction as late ones. Generally, the majority of the participants agreed that circumcision is not beneficial and should stop. Conclusion: Knowledge regarding the dangers of FGM among high school girls is better than expected given the high prevalence of the practice. Generally, the process is well understood, the performers are known, the experience is universal, and the side effects are acknowledged. Nevertheless, a majority still showed an intent to circumcise their daughters in the future. [ABSTRACT FROM AUTHOR]

The article provides an overview of the ongoing conflict in Sudan, which began in April between the Rapid Response Forces (RSF) and the Sudanese Army. The conflict is rooted in a power struggle between army leader Abd al-Fattah al-Burhan and RSF commander Muhammad Hamdan Daglo. Various external actors, including Saudi Arabia, the UAE, Egypt, the European Union, the US, and Israel, have become involved in the conflict due to their competing interests. The conflict in Sudan is similar to the situation in Libya, with rival factions, external support, and the potential for a proxy war. The conflict is driven by competition for control over valuable natural resources and has reignited ethnic and tribal conflicts. Achieving a sustainable peace agreement in Sudan will be challenging, and the conflict is expected to continue for an extended period. [Extracted from the article]

Background: Leishmania donovani is a protozoan parasite that causes visceral leishmaniasis, a potentially fatal disease in humans and dogs. The epidemiology and transmission dynamics of L. donovani in Sudan are poorly understood. We aim to determine the prevalence and characterization of L. donovani in human hospital cases and domestic dogs using different diagnostic methods in two localities in Gadarif State, Sudan. Methods: A cross-sectional study was conducted from October 2019 to April 2020. Whole blood samples and lymph node aspirates were collected from 69 human and 32 dog participants for parasitological, immunological, and molecular tests. Results: No parasites were detected in blood samples from either humans or dogs. Lymph node microscopy revealed 71.01% positivity in humans and 9.4% in dogs. The IT Leish test showed 82.6% positivity in humans and 43.75% in dogs. PCR confirmed L. donovani infection in all six selected samples (three from humans and three from dogs). Conclusion: The study confirmed the presence of L. donovani in both human and dog populations in the study area, suggesting that dogs may act as reservoirs or hosts for the parasite. The IT Leish kit test was the most sensitive and specific method, while microscopy of blood and lymph node smears was the least sensitive method. Further studies are needed to elucidate the role of dogs in the transmission cycle of L. donovani and the risk factors associated with human infection. [ABSTRACT FROM AUTHOR]

Background Malnutrition among adolescents is a considerable health problem worldwide. There are scarce data on undernutrition among adolescents in Sudan. Methods A cross‑sectional study was conducted to investigate the prevalence and associated factors of stunting and thinness among adolescent schoolchildren in northern Sudan. The questionnaires were used to collect information on sociodemographics. Weights and heights were measured and the height-for-age and body mass index-for-age cut-offs recommended by the WHO were applied, followed by logistic regression analysis. Results Of 384 enrolled adolescents, 202 (52.6%) were females and 182 (47.4%) were males. The median (IQR) age of these adolescents was 15.1 (14.0‒16.3) y. Seventy-six (19.8%) and 52 (15.4%) adolescents had stunting and thinness, respectively, and 15 (3.9%) had both stunting and thinness. Multivariate analysis showed that increased age (adjusted OR [AOR]=1.30, 95% CI 1.08 to 1.57) and male gender (AOR=5.82, 95% CI 3.11 to 10.91) were associated with stunting. Male gender (AOR=2.08, 95% CI 1.14 to 3.82) and smoking/tobacco snuff (AOR=2.61, 95% CI 1.07 to 6.36) were associated with thinness. Conclusions The findings of the current study are that both stunting and thinness are important health problems, especially among boys, older participants and smokers. [ABSTRACT FROM AUTHOR]

Copyright of Al-Mustansiriyah Journal for Pharmaceutical Sciences is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: This article presents a new analytical approach to acute malnutrition causal analysis that is different from the orthodox approach in 2 respects. First, it engages with basic causes, that is, beyond the usual focus on individuals and households. Second, it uses a relational view in the causal analysis. The orthodox approach identifies the malnourished and their individual and household characteristics. In contrast, a relational approach explores the ways in which the relationships between people, their livelihoods, and the environment, mediated by systems and institutions, create the underlying drivers associated with acute malnutrition for some, while simultaneously creating better conditions for others. Methods: The article draws on 2 case study communities in West Darfur, Sudan, first considering the Darfur context and the inequitable policies and weakened institutions that have led to ethnic polarization, multilayered conflict, and humanitarian crises. The article explores how this context has played out differently in each community, contrasting their livelihood specializations, conflict-related losses, and livelihood diversification over time. Findings: This analysis shows how the relative vulnerability of some people versus others is strongly influenced by their social, economic, and political relationships, as reflected in their shifting power relations and uneven control over livelihood resources. Conclusions: Shifting the focus to the basic drivers, especially the institutional structures, processes, and relationships, will deepen the causal analysis of child acute malnutrition, make it more meaningful, and provide a new direction for engagement, learning, and action to address the deepening problem of child acute malnutrition. Plain language title: A Relational Approach to the Drivers of Acute Malnutrition Plain language summary: This article introduces a new approach to understanding the causes of child acute malnutrition that differs from the traditional methods in 2 key ways. First, it goes beyond focusing solely on individuals and households by examining the underlying and basic causes. Secondly, it adopts a relational perspective in analyzing the causes. The traditional approach to studying the causes of acute malnutrition identifies malnourished individuals and examines their personal and household characteristics. In contrast, the relational approach looks at how the connections between people, their livelihoods, and the environment, influenced by systems and institutions, contribute to the development of acute malnutrition while also creating better conditions for some others. To illustrate this approach, the article presents findings from 2 communities in West Darfur, Sudan. It examines the Darfur context, including the policy and institutional context that has contributed to ethnic polarization and multiple conflicts and led to humanitarian crises. The article compares these 2 communities, focusing on their livelihood specializations, losses related to conflict, and changes in livelihood strategies over time. The article argues that by concentrating on the basic drivers of acute malnutrition, particularly the institutional structures, processes, and relationships, we can gain a deeper understanding of the issue. This approach can make the analysis of child acute malnutrition more meaningful and provide new insights for addressing this pressing problem. [ABSTRACT FROM AUTHOR]

Background: With students becoming more involved in the internet and social networking sites, they become more prone to their consequences. This study focuses on measuring the social networking intensity and the fear of missing out among the medical students of University of Khartoum, then examining the association between them. Methods: Facility-based, descriptive, cross-sectional study was conducted at Faculty of Medicine, Khartoum University between January and March 2021. A total of 333 students were selected by simple random sampling. Data was collected from the participants using a structured self-administered questionnaire that involved the social networking intensity (SNI) scale and fear of missing out (FOMO) scale. The data was analyzed by the Statistical Package for Social Science (SPSS) software version 26. Results: Moderate positive correlation between social networking intensity and fear of missing out was found (p-value < 0.01). Of the total participants; 51 participants (15.4%) experienced low SNI and low FOMO. Another 78 participants (23.6%) had moderate SNI and moderate FOMO and only 16 Participants (4.8%) showed high SNI and high FOMO. There were no significant differences in SNI or FOMO scores among the different socio-demographic variables, except for the SNI score which was positively correlated to the monthly income. Conclusion: An association between SNI and FOMO was found. SNI was not affected by socio-demographic factors except for the monthly income. [ABSTRACT FROM AUTHOR]

The article investigated the effect of multimedia in teaching science to secondary school students in Khartoum state. The study used descriptive analytical research by distributing a questionnaire to the study sample, which is science teachers for the academic year 2022/2023. The findings revealed that the impact of multimedia on students' achievement at the secondary level in science subjects in Khartoum was high, with a score of (3.69), indicating that multimedia increases students' motivation, facilitates access to useful educational resources, and valuable extracurricular contributions. Multimedia also contributes to achieving the teaching/learning goals more and enriches the knowledge of the teachers as well as enhances students' satisfaction and happiness. Multimedia also improves the academic performance of students in when teaching science. The findings also indicated that there is a statistically significant relationship between multimedia and students' attitudes. The study highlights several recommendations, the most important of which are the necessity of developing students' capabilities, training them in the use of multimedia and teaching cantered on students, and conducting several experimental studies that show the effectiveness of employing multimedia as an active learning strategy in the educational process in Sudan. [ABSTRACT FROM AUTHOR]

Background: Burnout prevalence and its consequences on healthcare workers during the Omicron wave are not well investigated in Sudan. This study aims to assess the prevalence of burnout and its associated factors among doctors and nurses during the omicron wave in COVID-19 isolation centres in Khartoum, Sudan. Method: This cross-sectional survey study was conducted at multiple COVID-19 isolation centres in Khartoum state during the omicron wave of Coronavirus Disease 2019 between 20th February 2022 and 10th April 2022. A total of 306 doctors and nurses filled out the questionnaire, with a response rate of 64.8℅. They were recruited from 5 isolation centers scattered in the three cities of Khartoum Metropolis. The level of burnout was assessed using an online semi-structured questionnaire based on the Oldenburg Burnout Inventory questionnaire. Descriptive statistics were used for continuous variables and frequencies with percentages for categorical variables. The Chi-square test and Fisher exact test were used to identify variables associated with burnout. Logistic regression was used to determine the factors associated with burnout, and the p-value of ≤.05 is considered statistically significant. Results: The prevalence of burnout was 45.7%. Doctors were more likely to have burnout than nurses (OR: 2.01, CI 95% 1.24–3.27; p = 0.005). Also, married healthcare workers were more likely to suffer burnout than single healthcare workers (OR: 3.89, CI 95% 1.41–12.5; P = 0.013). The number of household members (p = 0.035) was associated with burnout among participants. Conclusion: There is a high prevalence of burnout among healthcare workers in Khartoum Isolation Centers, which is more apparent among doctors. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa (P. aeruginosa) is known to be associated with resistance to practically all known antibiotics. This is a cross-sectional, descriptive, laboratory-based analytical study in which 200 P. aeruginosa clinical isolates were involved. The DNA of the most resistant isolate was extracted and its whole genome was sequenced, assembled, annotated, and announced, strain typing was ascribed, and it was subjected to comparative genomic analysis with two susceptible strains. The rate of resistance was 77.89%, 25.13%, 21.61%, 18.09%, 5.53%, and 4.52% for piperacillin, gentamicin, ciprofloxacin, ceftazidime, meropenem, and polymyxin B, respectively. Eighteen percent (36) of the tested isolates exhibited a MDR phenotype. The most MDR strain belonged to epidemic sequence type 235. Comparative genomic analysis of the MDR strain (GenBank: MVDK00000000) with two susceptible strains revealed that the core genes were shared by the three genomes but there were accessory genes that were strain-specific, and this MDR genome had a low CG% (64.6%) content. A prophage sequence and one plasmid were detected in the MDR genome, but amazingly, it contained no resistant genes for drugs with antipseudomonal activity and there was no resistant island. In addition, 67 resistant genes were detected, 19 of them were found only in the MDR genome and 48 genes were efflux pumps, and a novel deleterious point mutation (D87G) was detected in the gyrA gene. The novel deleterious mutation in the gyrA gene (D87G) is a known position behind quinolone resistance. Our findings emphasize the importance of adoption of infection control strategies to prevent dissemination of MDR isolates. [ABSTRACT FROM AUTHOR]

Objectives: Hashimoto's thyroiditis (HT) is the most common cause of hypothyroidism. The exact mechanism initiating the development of HT is not yet clear. This study aimed to investigate the correlation between HT and the presence of Epstein-Barr virus (EBV) in a Sudanese population. Results: EBV-LMP1 was detected in 11.1% of HT cases, which is consistent with previous studies. Studies have reported a wide range of frequencies indicating the presence of EBV in HT, and patients with autoimmune thyroiditis have increased titers of anti-EBV antibodies in their sera compared to healthy subjects. Intrathyroidal EBV-infected B cells may be responsible for the increased risk of development of B-cell lymphoma in the thyroid gland in patients with autoimmune thyroiditis. Our study suggests that regular follow-up is necessary for patients diagnosed with HT and are positive for EBV, as antiviral therapy is not applicable due to the risk of thyroid dysfunction. The study suggests an association between EBV and HT, but causation cannot be determined. The study also highlights the need for further research to determine the viral role and correlate it with the severity and progression of HT. [ABSTRACT FROM AUTHOR]

Background: Access to essential medicines is a critical component of universal health coverage. However, the availability of essential medicines in Sudan isn't well studied. As well, most Sudanese people lack health insurance, making out-of-pocket spending the primary source of drug financing. Therefore, the affordability of medicines in Sudan is questionable, with only 30% of the total population being covered by a public health service or public health insurance. We undertook this study to assess the availability and prices of essential medicines in public-sector health facilities in Khartoum state. Moreover, this study aims at assessing patients' perceived affordability of essential medicines, and accommodation and acceptability of the public facility. Methods: A cross-sectional study was carried out at 30 primary healthcare facilities' drug dispensaries across three districts in Khartoum state. Within each Centre's dispensary unit, a standardized checklist evaluated the availability and affordability of 21 essential medicines selected from Sudan's national essential medicines list and assessed their storage conditions. Furthermore, 630 patients were selected from all dispensary units for an exit interview that assessed their perceived accessibility, acceptability, accommodation, and affordability of essential medicines. Data were collected through the Kobo toolbox and analyzed using SPSS version 26. Results: Participants' ratings of accessibility, affordability, accommodation, and acceptability were 3.7/5, 1.5/4, 5/6, and 5.4/6, respectively, with a 26.7% full access and weak correlation between some of the indices. The overall availability of adults and pediatric medicines was 36.8% 6.7%, respectively. Cost of a single course of treatment for 10 and 16 drugs out of the 19 drugs consumed exceeds the daily wage of insured and uninsured patients, with a median price ratio of 16.4 and 62.8, respectively. Moreover, the dispensary area conditions were found to be of good quality, yet the storerooms were not functioning in 40% of the outlets. Conclusion: Patients had limited access to their needed drugs due to high prices and physical unavailability, and primary healthcare capacities are not meeting the demands of citizens. The outcomes for the patients' access variables (accessibility, accommodation, acceptance, and affordability) are comparable to those in countries with low incomes. Ensuring access to free medicines is likely to improve patients' satisfaction with healthcare services and reduce private expenditure on medicines, which is a long-term, sustainable way towards universal health coverage in Sudan. [ABSTRACT FROM AUTHOR]

Background: Adult renal cell carcinomas account for 80-85% of all renal tumors, making them the most common primary renal tumors. As a method for categorizing renal masses by anatomical characteristics, R.E.N.A.L score is suggested to study the effect on surgical approach in addition to perioperative outcomes and complications. Methods: A cross-sectional prospective hospital-based study enrolled 48 RCC patients in GHRDS in the period between September 2020 and September 2021. Data regarding demographics, histological subtypes, surgical approach, intraoperative and postoperative complications were collected. Based on R.E.N.A.L score, the complexity of renal tumors is grouped into low, moderate, and high. Results: The study sample size was 48. Twenty-five participants (52.1%) were men with a mean age of 51 years. Most cases had clear cell RCC 22 (45.8%) and papillary RCC 19 (39.6%). Thirty-nine (81.5%) patients underwent radical nephrectomy (flank incision [extraperitoneal] in 32 [82.1%] and midline incision [transperitoneal] in 7 [17.3%]), and 9 (18.5%) patients underwent partial nephrectomy. One-third of the patients 15 (31.2%) had intraoperative complications and 7 (14.6%) had postoperative complications. All intraoperative and most postoperative complications were associated with radical nephrectomy (P = 0.001). According to complexity, 21 (43.8%) patients had moderate complexity, 15 (31.2%) high complexity, and 12 (25%) low complexity. Conclusion: Most RCC patients had moderate complexity and were subjected to radical nephrectomy. High complexities were linked to decision of radical nephrectomy, intraoperative and postoperative complications. More prospective research with large sample size and multi-centered studies is essential to ensure generalizability of study findings. [ABSTRACT FROM AUTHOR]

Grid-connected rooftop solar photovoltaic (PV) systems can reduce the energy demand from the grid and significantly increase the power available to it. However, rooftop solar PV has not yet been widely adopted in many sub-Saharan African countries, such as Sudan, although they are endowed with high solar radiation and in dire need of additional power. This paper investigates risks and policies to increase grid-connected rooftop solar PV adoption in Sudan. A simplified United Nations Development Program Derisking Renewable Energy Investment framework is adopted to investigate this over three stages. For Stage 1, a list of risks and barriers was produced based on a literature review of solar PV studies in Sudan and interviews with nine stakeholders. Affordability was the risk most often mentioned (eight times from nine interviewees), followed by concerns about poor utility grid infrastructure. For Stage 2, policy de-risking instruments and financial de-risking instruments were listed to overcome the barriers. These include the introduction of net metering, the use of a third-party organization to monitor policy implementation, upgrade of the grid infrastructure, public awareness campaigns and energy-saving schemes. For Stage 3, the levelized cost of electricity was estimated for a typical 2-kW rooftop PV system without policies (0.11 $/kWh) and with a net-metering policy (0.07 $/kWh). [ABSTRACT FROM AUTHOR]

Background and Objectives: HIV disease is recognized to cause inconsistencies in coagulation via various pathways during infection. Some studies have indicated that HIV-infected patients are prone to developing thrombocytopenia, thrombosis, or autoantibodies that may cause difficulties in diagnosis. This study is intended to measure the trend of coagulation parameters in Sudanese patients with HIV. Materials and Methods: A cross-sectional study was carried out in patients with HIV admitted to the Sudan National AIDS Program (SNAP) from January 2018 to December 2019. Prothrombin time (PT), partial thromboplastin time (PTT), thrombin time (TT), D-dimer (DD), hemoglobin (HB), total lymphocyte count (TLC), platelet count (PLT), and a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13 (ADAMTS13), were evaluated among HIV Sudanese patients. Results: Out of the 44 HIV patients included, 6 (13.6%) were found to have thrombotic thrombocytopenic purpura-like events and 12 (27.2%) had antiphospholipid antibodies, of whom 8 (66.6%) showed anticardiolipin antibody (1gG (75%) and IgM (25%)) and 4 showed lupus anticoagulants. The HB, TLC, and PLT values were found to be significantly lower in HIV patients than in control (p = 0.000, 0.000, and 0.050, respectively). The PT and ADAMTS13 values showed no significant difference between HIV patients and control (p = 0.613 and 0.266, respectively). The PTT, TT, and DD values were found to be augmented in HIV patients versus the control (p = 0.000). Conclusions: Thrombotic thrombocytopenic purpura-like events among HIV Sudanese patients were explored. In addition, antiphospholipid antibodies were strikingly seen in these patients. Additional research is anticipated to confirm these diagnoses. [ABSTRACT FROM AUTHOR]

The ongoing armed conflict in Sudan has resulted in a deepening humanitarian crisis with significant implications for the country's health system, threatening its collapse. This article examines the destruction, disruption, and disastrous consequences inflicted upon Sudan's health system. The conflict has led to the severe compromise of healthcare facilities, with only one-third of hospitals in conflict zones operational. Artillery attacks, forced militarization, power outages, and shortages of medical supplies and personnel have further crippled the health system. The exodus of health workers and escalating violence have exacerbated the crisis. Disrupted service delivery has resulted in the interruption of essential health services, including obstetric care, emergency services, and dialysis. Financial losses to the health system are estimated at $700 million, impacting an already underfunded sector. We identify that in addition to restoration of peace and mobilization of urgent aid, immediate prioritization of the reconstruction of the health system is crucial to mitigate the long-term consequences of the war. Rebuilding a resilient health system is sine qua non for Sudan's progress towards universal health. [ABSTRACT FROM AUTHOR]

Honey from Apis mellifera and Apis florea was collected from western and eastern regions of Sudan and investigated for quantitative/qualitative pollen analysis, organoleptic characterisation, and antibacterial analysis. Nearly 29 different pollen taxa belonging to 19 families were identified. Based on the frequencies determined: Leguminosae (≥ 10) was the dominant family, Poaceae and Amaranthaceae were sporadic (9–3) whereas Cyperaceae was rare (< 3). Herbs represented 52%, trees 38%, and shrubs 10%. Pollen from both cultivated and wild vegetation was identified. The taxa identified are angiospermous and no gymnospermous species were encountered. Four anemophilous pollen types were observed. Pollen of particular interests, such as Borassus aethiopum and Hyphaena thebaica, was also found. Calotropis procera and Leptadenia spp. were also observed in the current investigation; these pollen taxa are of infrequent occurrence in honey especially in Sudan and the nectar of these plants are claimed to contain poisonous substances. Pollen grains of the Combretaceae with a unique heterocolpate sculpture were found only, in Al Leeri representing a clear uniflorality of honeys in the area. The organoleptic analysis revealed statistically significant differences in pH (p ≤ 0.001), ash (p ≤ 0.03), sucrose (p ≤ 0.04), and electrical conductivity (p ≤ 0.05). Respectively, honey from A. florea had higher sodium (17.647, 6.753 mg/kg) and higher phosphorus (2.900, 2.080 mg/kg) than honey from A. mellifera. Whereas honey from A. mellifera, had higher manganese (0.218–0.151 mg/kg) than honey from A. florea, both honeys exhibited similar antibacterial potency against Staphylococcus aureus and Salmonella typhi. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a chronic elevation of blood pressure that, in the long-term, causes end organ damage and results in increased morbidity and mortality. Thrombosis often appears to complicate the course of patients with hypertension; thrombosis in some patients with hypertension could be developed to organ damage. The aim of this study was to measure fibrinogen and D-dimer level among sudanese patients with hypertension. Materials and method: This was a case control study conducted at Khartoum state, Sudan during the period from May 2022 to August 2022 to measure fibrinogen and D-dimer levels in sudanese patients with hypertension. Blood samples were collected, 50 from the patients as case group, and 50 from normal healthy subjects as control group. A total of three ml of whole blood were collected from each participant in sodium citrated tube. The fibrinogen and D-dimer level measurement was done by using coagulometer (M1 coatron) and ichroma II device respectively. Results: The results of this study revealed that when compared Fibrinogen level and D-dimer between cases and control group; the results revealed that fibrinogen level was significant increase in hypertensive patients with P-value of 0.000. Also, D-dimer was significant increase in hypertensive patients when compared with the results of control group, and showed significant association with P-value of 0.000. There was a negative correlation between hypertension and the gender, but the age showed positive correlation with hypertension and with D-dimer, where both fibrinogen and D-dimer showed positive correlation with the duration of hypertension. Conclusion: This study concluded; when compared the fibrinogen level and D- dimer between cases and control group, there was significant increase in fibrinogen and D- dimer. [ABSTRACT FROM AUTHOR]

Background: Globally, hypertension represents a major public health problem. The association between 25-hydroxyvitamin D (25[OH]D) levels and hypertension remains unclear. The current study aimed to investigate the association between serum 25(OH)D levels and hypertension among adults in Sudan. Methods: A community-based cross-sectional study was conducted among adults in North Sudan. Sociodemographic and clinical data were collected using a questionnaire and face-to-face interviews. Serum 25(OH)D was measured using an enzyme-linked immunosorbent assay. Multivariate logistic regression and multiple linear regression analyses were performed. Results: Of the total of 391 participants, 202 (51.7%) were females. The median (interquartile range [IQR]) of participants' ages was 45(32–55) years. Of the total, 219(56.0%) had hypertension. The median (IQR) of serum25(OH)D was 13.3(9.9–19.7) ng/mL, and 295 (75.4%) participants had vitamin D deficiency (< 20 ng/mL). In multivariable logistic regression, the adjusted odds ratio (AOR) for age = 1.05, 95% confidence interval (CI)1.03‒1.061, the AOR for being female = 2.02, 95% CI, 1.12‒3.66, and body mass index was AOR = 1.09, 95% CI, 1.05‒1.14, all of which were significantly associated with hypertension. However, serum 25(OH)D levels were not associated with hypertension (AOR = 1.01, 95% CI 0.99‒1.05, P = 0.317). In multiple linear regression, while systolic blood pressure was negatively associated with 25(OH)D (coefficient = − 0.28, P = 0.017), there was no significant association between serum 25(OH)D level and diastolic blood pressure (coefficient = − 0.10, P = 0.272) or mean blood pressure (coefficient =–0.03, P = 0.686). Conclusion: The current study revealed a negative association between vitamin D and systolic blood pressure. The mechanism of such an association needs further study. [ABSTRACT FROM AUTHOR]

Mapping of land use/ land cover (LULC) dynamics has gained significant attention in the past decades. This is due to the role played by LULC change in assessing climate, various ecosystem functions, natural resource activities and livelihoods in general. In Gedaref landscape of Eastern Sudan, there is limited or no knowledge of LULC structure and size, degree of change, transition, intensity and future outlook. Therefore, the aims of the current study were to (1) evaluate LULC changes in the Gedaref state, Sudan for the past thirty years (1988–2018) using Landsat imageries and the random forest classifier, (2) determine the underlying dynamics that caused the changes in the landscape structure using intensity analysis, and (3) predict future LULC outlook for the years 2028 and 2048 using cellular automata-artificial neural network (CA-ANN). The results exhibited drastic LULC dynamics driven mainly by cropland and settlement expansions, which increased by 13.92% and 319.61%, respectively, between 1988 and 2018. In contrast, forest and grassland declined by 56.47% and 56.23%, respectively. Moreover, the study shows that the gains in cropland coverage in Gedaref state over the studied period were at the expense of grassland and forest acreage, whereas the gains in settlements partially targeted cropland. Future LULC predictions showed a slight increase in cropland area from 89.59% to 90.43% and a considerable decrease in forest area (0.47% to 0.41%) between 2018 and 2048. Our findings provide reliable information on LULC patterns in Gedaref region that could be used for designing land use and environmental conservation frameworks for monitoring crop produce and grassland condition. In addition, the result could help in managing other natural resources and mitigating landscape fragmentation and degradation. [ABSTRACT FROM AUTHOR]

Background: One of the most common surgical emergencies, intestinal obstruction is rarely the result of an inadvertently retained foreign object (also known as a gossypiboma), which may not present symptoms for a lifetime. It also carries additional legal burdens, which may account for the rarity of its reports. Case presentation: We report a 24-year-old Sudanese female with a history of emergency Caesarean section two years before the admission presented with abdominal distension and absolute constipation, which was diagnosed as intestinal obstruction with a retained gauzed found within the small intestine. Moreover, a review of recent African-reported cases was done to find relatively similar cases. Conclusion: Adhering to the standard of care in surgical theaters and integrating new methods of prevention like tagged gauze could help to decrease the rate of such cases in the future. [ABSTRACT FROM AUTHOR]

Background: Worldwide, renal cell carcinoma comprises 2.2% and 1.8% of global cancer incidence and mortality, respectively. Studies of epidemiology, treatment modalities and outcomes of renal cell carcinoma (RCC) in Sudan are scarce. To address this shortcoming, we evaluated baseline information on the epidemiology, types of treatment and outcomes of RCC at Gezira Hospital for Renal Diseases and Surgery (GHRDS) and the National Cancer Institute (NCI). Methods: We performed a retrospective, descriptive study of all patients with RCC, who were treated in GHRDS and NCI from January 2000 to December 2015. Results: A total of 189 patients with RCC were identified over the study period. Tumours were more common among male patients (56%) and involved the left kidney in 52% of cases. The median age at diagnosis was 57 years (range: 21-90 years). Loin pain was the most frequent symptom (n = 103 patients) followed by weight loss (n = 103 patients) and haematuria (n = 65 patients). The most common histopathologic type of RCC was clear cell (73.5%), followed by papillary (13.8%) and chromophobe (1.6%). The relative frequencies of stages I-IV were 3.2%, 14.3%, 29.1% and 53.4%, respectively. The overall median survival rate was 24 months, and the 5-year survival rate was 40%. The 5-year survival rate in stages I-IV was 95%, 83%, 39%, and 17%, respectively. Advanced stages and higher-grade tumour were associated with worse survival. The median survival of stage IV patients was better for patients who underwent nephrectomy (11.0 months) compared to those who did not undergo nephrectomy (4.0 months) (p value = 0.28). Conclusion: Our findings reveal poor outcomes for patients with RCC in Sudan, which is most likely due to the high proportion of patients presenting with advanced stages at the time of initial presentation. [ABSTRACT FROM AUTHOR]

Background: Providing quality medical education in Sudan faces challenges due to armed conflicts. This short communication explores practical solutions for ensuring the continuity of medical education during the conflict in the Sudanese context. Methods: A comprehensive literature review covered relevant articles published from 1915 to 2023. Four major databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched using keywords related to medical education, war, armed conflict, and affected countries. Data synthesis identified common themes, challenges, and trends and suggested solutions for medical education in conflict zones. Case studies from Ukraine, Liberia, and Iraq were included for a comprehensive understanding. Results: Collaborative alliances among medical schools facilitate resource sharing and support. Engaging the Sudanese diaspora through 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 learning and social media platforms, overcome access barriers and fosters knowledge sharing. Ambulatory teaching provides practical experience and adaptability. Prioritizing faculty well-being and professional development through training and support is crucial. Emphasizing resilience and adaptability in student education prepare them for healthcare delivery in resource-limited settings. Research and innovation contribute to evidence-based strategies. International collaboration and support offer opportunities for knowledge exchange and infrastructure improvement. Conclusion: Implementing collaborative strategies and innovative approaches helps Sudanese medical schools overcome challenges during armed conflicts and maintain quality medical education. These solutions empower students and faculty, enhance resilience, and contribute to improving healthcare systems in post-war Sudan. [ABSTRACT FROM AUTHOR]