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Abstract Background Despite global efforts to reduce and eventually interrupt malaria transmission, the disease remains a pressing public health problem, especially in sub-Saharan Africa. This study presents a detailed spatio-temporal analysis of malaria transmission in Rwanda from 2012 to 2022. The main objective was to gain insights into the evolving patterns of malaria and to inform and tailor effective public health strategies. Methods The study used yearly aggregated data of malaria cases from the Rwanda health management information system. We employed a multifaceted analytical approach, including descriptive statistics and spatio-temporal analysis across three demographic groups: children under the age of 5 years, and males and females above 5 years. Bayesian spatially explicit models and spatio scan statistics were utilised to examine geographic and temporal patterns of relative risks and to identify clusters of malaria transmission. Results We observed a significant increase in malaria cases from 2014 to 2018, peaking in 2016 for males and females aged above 5 years with counts of 98,645 and 116,627, respectively and in 2018 for under 5-year-old children with 84,440 cases with notable geographic disparities. Districts like Kamonyi (Southern Province), Ngoma, Kayonza and Bugesera (Eastern Province) exhibited high burdens, possibly influenced by factors such as climate, vector control practices, and cross-border dynamics. Bayesian spatially explicit modeling revealed elevated relative risks in numerous districts, underscoring the heterogeneity of malaria transmission in these districts, and thus contributing to an overall rising trend in malaria cases until 2018, followed by a subsequent decline. Our findings emphasize that the heterogeneity of malaria transmission is potentially driven by ecologic, socioeconomic, and behavioural factors. Conclusions The study underscores the complexity of malaria transmission in Rwanda and calls for climate adaptive, gender-, age- and district-specific strategies in the national malaria control program. The emergence of both artemisinin and pyrethoids resistance and persistent high transmission in some districts necessitates continuous monitoring and innovative, data-driven approaches for effective and sustainable malaria control. Graphical Abstract

Abstract Background Malaria remains an important public health problem, particularly in sub-Saharan Africa. In Rwanda, where malaria ranks among the leading causes of mortality and morbidity, disease transmission is influenced by climatic factors. However, there is a paucity of studies investigating the link between climate change and malaria dynamics, which hinders the development of effective national malaria response strategies. Addressing this critical gap, this study analyses how climatic factors influence malaria transmission across Rwanda, thereby informing tailored interventions and enhancing disease management frameworks. Methods The study analysed the potential impact of temperature and cumulative rainfall on malaria incidence in Rwanda from 2012 to 2021 using meteorological data from the Rwanda Meteorological Agency and malaria case records from the Rwanda Health Management and Information System. The analysis was performed in two stages. First, district-specific generalized linear models with a quasi-Poisson distribution were applied, which were enhanced by distributed lag non-linear models to explore non-linear and lagged effects. Second, random effects multivariate meta-analysis was employed to pool the estimates and to refine them through best linear unbiased predictions. Results A 1-month lag with specific temperature and rainfall thresholds influenced malaria incidence across Rwanda. Average temperature of 18.5 °C was associated with higher malaria risk, while temperature above 23.9 °C reduced the risk. Rainfall demonstrated a dual effect on malaria risk: conditions of low (below 73 mm per month) and high (above 223 mm per month) precipitation correlated with lower risk, while moderate rainfall (87 to 223 mm per month) correlated with higher risk. Seasonal patterns showed increased malaria risk during the major rainy season, while the short dry season presented lower risk. Conclusion The study underscores the influence of temperature and rainfall on malaria transmission in Rwanda and calls for tailored interventions that are specific to location and season. The findings are crucial for informing policy that enhance preparedness and contribute to malaria elimination efforts. Future research should explore additional ecological and socioeconomic factors and their differential contribution to malaria transmission.

A Rift Valley fever epizootic affected livestock in Rwanda during March–October 2022. We confirmed 3,112 infections with the virus, including 1,342 cases, 1,254 abortions, and 516 deaths among cattle, goats, and sheep. We recommend a One Health strategy for investigations and response to protect animal and human health.

Abstract Satellite swarm networks have occupied a prominent position in many modern applications due to their low cost, simplicity of design, and flexibility. Reliability is an influential factor in the design of satellite networks with different structures. Usually, small satellites are based on COST components, which may reduce continues operability due to the lack of using backup system on board the sagecraft. Any failure in one subsystem means a complete loss of the function and data stored in this subsystem; hence the need for a reliable and applicable solution for this matter is a crucial topic. Using the redundancy strategy in satellite swarm networks increases reliability and availability. Blockchain is characterized by using a distributed ledger which enables the database to be replicated across nodes in the network and results in increasing transparency, security, and trust. This paper suggests adoption of blockchain technology in distributed multi-satellite mission swarm networks to provide a high level of reliability and availability of the entire system; the blockchain is usually used to secure system transactions in multilayer approach by storage of the key parameters in more than one node; here we suggest the adoption of this approach not only to secure satellite network transaction, but also to increase system reliability so that failure of one node can be recovered by other nodes. We compared this approach with similar traditional networks that do not use blockchain. The results show a higher reliability efficiency of 95.3% for applying blockchain technology compared to 64.3% without the use of blockchain, as well as a higher availability of 99% compared to 91%.

Abstract Botryomycosis of the tongue is a rare chronic bacterial infection that presents as nodular masses, mimicking other infectious or neoplastic conditions such as mycetoma. A case of an 80‐year‐old male was presented with painless swelling on the right lateral side of his tongue to the outpatient clinic. Biopsy and microbiological investigations revealed an unexpected Staphylococcus aureus‐related botryomycosis. This case highlights the diagnostic challenge for unusual clinical presentations of bacterial infections. Healthcare providers in countries endemic with diseases that manifest similarly should investigate thoroughly to ensure a positive clinical outcome through early diagnosis and effective case management.

Key Clinical Message This case highlights the significant challenges in the diagnosis and management of eumycetoma, particularly in regions like Sudan, where socioeconomic factors and ongoing conflict severely impact patient care. Delayed diagnosis and inadequate access to effective treatment can lead to poor adherence to prescribed therapies, prompting patients to resort to unproven self‐treatment methods. Comprehensive, multidisciplinary approaches that include education, improved accessibility to care, and addressing the impact of social determinants on health are essential to enhance the management of mycetoma, reduce disability rates, and improve patient outcomes in underserved communities. Abstract Mycetoma is a chronic and debilitating infectious disease characterized by localized swellings and granulomatous lesions. It primarily affects individuals in tropical and subtropical regions and is caused by certain fungi or bacteria. This case report outlines the presentation, diagnosis, and management of a 37‐year‐old male from central Sudan with black grain eumycetoma, a challenging condition. The patient presented with recurring painless swelling in his right foot, which progressed over 5 years to include sinuses discharging black grain‐like materials. Despite initial treatment with itraconazole and folic acid, the patient discontinued medication due to war‐induced hardships including financial and accessibility to treatment and healthcare guidance, resulting in resorting to none‐effective and potentially harmful herbal remedies. Multidisciplinary management involving dermatologists, infectious disease specialists, and pharmacists supported with community health workers for health education is essential for enforcing adherence to treatment and successful recovery.

Abstract Background Globally, there are regional and time-based variations in the prevalence, etiology, and prognosis of rapidly progressive glomerulonephritis (RPGN). Prognosis of RPGN is poor, with a higher risk of death and end stage renal disease (ESRD) even with immunosuppressive medications. In the Middle East and North Africa, the studies on this disease are very limited. Therefore, we determined the predictors of outcome of RPGN. Methods We retrospectively assessed 101 adult patients over age of 18, diagnosed with RPGN based on renal biopsy illustrating crescents in ≥ 50% of the glomeruli. Patients who had crescents in their renal biopsies that were

Key Clinical Message In countries like Sudan, where several infectious diseases are prevalent, health care providers should not be satisfied with initial detection of a single pathogen and whenever it is feasible, they should investigate coinfections. Infections with high mortality or severe morbidity should be prioritized during the differential diagnosis particularly for diseases with similar clinical manifestations to reduce the death and disability rates. However, this requires substantial improvement in the diagnostic capacity. Abstract Here we report a case of dengue and malaria coinfection from the southeast region of Sudan, bordering Ethiopia and Eritrea. A 25‐year‐old male from Sudan presented with symptoms of fever, chills, vomiting, and muscle and joint pain. Laboratory investigations confirmed a coinfection of dengue and malaria, which is assumingly not uncommon in areas heavily syndemic with several diseases but it is severely under‐detected, underreported, and underestimated. The case has fully recovered after the supportive care for dengue and chemotherapy treatment for malaria. In such a case, it was important to monitor the patient's recovery and the treatment outcome through clinical indicators and laboratory parameters to update the treatment course whenever needed, according to response. The increasing burden and outbreaks of vector‐borne diseases including dengue and malaria in Sudan, indicates the need for improving the implementation of the global vector control response that established by the World Health Organization. Additionally, the increasing prevalent of coinfections is urging substantial improvement in the diagnostic capacity in endemic countries.

The Africa Centers for Disease Control and Prevention declared mpox a Public Health Emergency of Continental Security (PHECS) in Africa. African public health systems have moved to mobilize a response against a backdrop of inherent significant challenges. With this commentary, we discuss how lessons from past public health emergencies, particularly COVID-19 and Ebola outbreaks, have prepared the region for improved disease surveillance, rapid response strategies, and effective public health communication and how these lessons can be applied to the mpox response, emphasizing the importance of strong healthcare infrastructure, effective data sharing, community engagement, targeted interventions, and robust contact tracing. Additionally, addressing misinformation and building public trust are crucial for controlling the spread of any disease. By leveraging these strategies, African countries can enhance their response to mpox. This includes improving diagnostic capabilities, strengthening cross-border collaborations, and prioritizing vaccination campaigns where needed. Ultimately, by applying the hard-earned lessons from the COVID-19 pandemic and Ebola outbreak, the East Africa region can better address the challenges posed by mpox and safeguard public health.

Fungal infections (FIs) are spreading globally, raising a significant public health concern. However, its documentation remains sparse in Africa, particularly in Rwanda. This report provides a comprehensive review of FIs in Rwanda based on a systematic review of reports published between 1972 and 2022. The findings reveal a rich diversity of fungal pathogens, including Blastomyces, Candida, Cryptococcus, Histoplasma, Microsporum, Pneumocystis, Rhinosporidium, and Trichophyton caused human infections. Candida infections predominantly affect the vagina mucosa, while Histoplasma duboisi was linked to disseminated infections. Other pathogens, such as Blastomyces dermatitidis and Rhinosporidium seeberi, were associated with cerebellar and nasal mucosa infections, respectively. The widespread observation of soilborne fungi affecting bean crops highlights the pathogens’ threat to agricultural productivity, food security, and socioeconomic stability, as well as potential health impacts on humans, animals, and the environment. Of particular importance is that there is no information about FIs among animals in the country. Moreover, the analysis underscores significant limitations in the detection, reporting, and healthcare services related to FIs in the country, indicating gaps in diagnostic capacity and surveillance systems. This is underscored by the predominant use of traditional diagnostic techniques, including culture, cytology, and histopathology in the absence of integrating more sensitive and specific molecular tools in investigating FIs. Developing the diagnostic capacities and national surveillance systems are urgently needed to improve the health of crops, animals, and humans, as well as food security and socioeconomic stability in Rwanda. Also, it is important to indicate severe gaps in the evidence to inform policymaking, guide strategic planning, and improve healthcare and public health services, underscoring the urgent need to build national capacity in fungal diagnosis, surveillance, and research. Raising awareness among the public, scientific community, healthcare providers, and policymakers remains crucial. Furthermore, this report reveals the threats of FIs on public health and food insecurity in Rwanda. A multisectoral one health strategy is essential in research and intervention to determine and reduce the health and safety impacts of fungal pathogens on humans, animals, and the environment.

Abstract 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.

Background: Small ruminants have a socioeconomic impact on Egypt's production of meat, milk and wool. Hence, every effort should be taken to prevent infections. Aim: To elucidate the prevalence and serogrouping of Escherichia coli (E. coli) strains from diarrheic lambs and kids, determine their antibiotic susceptibility and associated risk factors affecting the occurrence of the disease and establish the most common virulence genes marker and major antimicrobial resistance (AMR) genes. Methods: A total of 150 diarrheic animals (95 lambs and 55 kids) at different age and seasons were subjected to clinical examination. Rectal swabs were collected from 150 diarrheic animals for isolation and biochemical identification of E. coli. Results: The bacteriological examination revealed that 62/95 lambs and 26/55 kids with percentages of 65 % and 47 %, respectively showed infection with E. coli. Serotyping of 88 isolates of E. coli revealed the strains belonging to O2(8), O55(17), O84(5), O17(4), O6(8), O91(17), O26(9), O103(5), O126(5) and O124(6), O159(4). A total of 21 isolates were examined by multiplex Polymerase Chain Reaction (PCR) assay for detection of virulence and resistance genes. All examined isolates possessed a combination between intimin gene (eaeA) and heat stable toxin (STa) (100%), the serine protease (pic) gene on 8/21 isolates of O55, O2, O6 (38%) and α-hemolysin (hlyA) gene on 8/21 isolates of O26, O91(38%) while adherent invasive gene (invA) gene on 3/21 isolates of O124, O159 (14%) which divided diarrheagenic E. coli into four types assigned to be atypical enteropathogenic E. coli (aEPEC) (48%), atypical enterohemorrhagic E. coli (aEHEC) (35%), atypical enterotoxigenic E. coli (aETEC) (6%) and atypical enteroinvasive E. coli (aEIEC) (11%). On other hand, the results of antimicrobial susceptibility testing (AST) revealed high resistance to ampicillin, erythromycin and tetracycline (100%) and amoxicillin/clavulanic acid (92%) but were highly sensitive to gentamicin, imipenem, norfloxacin, ciprofloxacin, chloramphenicol and amikacin (100%). Concerning to ß lactams antibiotic resistance genes of examined isolates had blaSHV (100%) and BlaCTX-M (43%). For tetracycline, we detected the tetA in all examined isolates. Conclusion: The wide spread of atypical E. coli strains among diarrheic lambs and kids with marked resistance to several antibiotic of interest and detection of major resistance genes assess the potential risk of this pathogen to animal and public health. [Open Vet J 2023; 13(9.000): 1106-1115]

Background: Although the potential influence of numerous systemic diseases on the periodontium is well established, periodontal infection may significantly enhance liability to or modify the progression of certain systemic diseases, such as diabetes mellitus and hypertension. These are the most common disorders sharing a pathogenesis that involves an enhanced local and systemic inflammatory response to periodontal bacteria. The current study was intended to assess the correlation of periodontal disease severity with diabetes mellitus and/or hypertension. Methods: This study analyzed the records of patients who visited the hospital in 2018. Age, gender, periodontal disease severity and systemic condition, were obtained from patients’ records without including any identifying information. Data were gathered, arranged in tables, and analyzed using the chi-squared test (X2) and Pearson correlation coefficient (r). Significance was determined when P-values were < 0.05. Results: The frequencies of gingivitis and chronic periodontitis were greater in males than in females (p = 0.001 and 0.000, respectively). Periodontal disease severity was found to increase with age (p = 0.000). The frequency of chronic periodontitis was statistically higher than that of gingivitis (p = 0.000) and the frequency of severe chronic periodontitis was statistically higher than that of moderate and slight chronic periodontitis in all patients, whether they had diabetes mellitus and/or hypertension (p = 0.000). Conclusions: A large significant difference was found between the frequency of chronic periodontitis and that of gingivitis in all diabetic and/or hypertensive patients. Moreover, the severity of chronic periodontitis had a significant positive correlation with diabetes mellitus and/or hypertension.

Abstract Background Role of Long non-coding RNAs in cancer research in the recent years have been highlighted with evidence to their involvement in cancer disease pathogenesis and progression. One of these emerging long non-coding RNAs is differentiation antagonizing non-protein coding RNA (DANCR). DANCR distinct expression in different cancers and implication in tumor signaling pathways made it a promising therapeutic target for cancer. The purpose of this study was to evaluate DANCR expression in de novo acute myeloid leukemia (AML) patients and to assess DANCR expression in relation to cytogenetics and French American British (FAB) AML classification as well as correlate DANCR expression with patients’ response to treatment. The present study included 60 newly diagnosed AML patients and 30 healthy subjects as controls. Relative DANCR expression was done using real time qPCR method. Results DANCR was significantly downregulated in AML patients compared to controls (p = 0.038). In addition, DANCR showed significantly lower expression in M4 and M5 compared to M0, M1, and M2 groups (p

Knowledge management is one of the latest administrative concepts because of its human and intellectual capital, and it represents the basis on which project management and development are based and the basis of competitive advantage in construction companies. This is what causes managers and building experts to light and attention to managing knowledge to improve performance and better practicing the construction industry. However, many construction companies, especially medium and small enterprises, still do not effectively manage knowledge, with much lost financial burden and waste much experience, information, and knowledge without realizing the importance of lost knowledge and also what it takes to redefine lost knowledge. Therefore This paper aims to study the role provided by knowledge management to improve the performance of construction companies by reviewing the relationship between knowledge management and improving the performance of construction companies in the light of the available literature and previous studies using the descriptive analytical approach to stand on two main axes for any knowledge system applied in The two construction companies are: the effective supporting factors in the knowledge management systems, and the second is the obstacles facing the implementation of the current knowledge management systems. The result of the study is that supporting the culture of knowledge management, support from senior management, supporting information technology, and training continuous of employees are among the most important critical success factors shown by previous field studies. The obstacles differ according to the work environment and place of study. The research hypothesis was confirmed, which is that knowledge management improves the performance of construction companies, as it affects project performance, affecting project performance, company performance, employee performance, and knowledge effectiveness within the company. This research is the nucleus for decision-makers and those working to develop the performance of construction companies and the setters of strategies and knowledge systems to improve performance and achieve the required final output in the construction industry. تعد إدارة المعرفة من أحدث المفاهيم الإدارية لما تضمنته من رأس مال بشري وفكري ويمثل الأساس الذي يرتكز عليه تقدم إدارة المشروعات وتطورها وأساس الميزة التنافسية في شركات البناء. هذا ما يجعل المدراء وخبراء البناء يلقون الضوء والاهتمام لإدارة المعرفة لأجل تحسين الأداء وممارسة أفضل لصناعة البناء. ولكن لا يزال الكثير من شركات البناء بخاصة المتوسطة والصغيرة لا تفعل دور إدارة المعرفة بشكل فاعل مما يكبدها الأعباء المإلىة الكثيرة الضائعة وتهدر الكثير من الخبرات والمعلومات والمعرفة دون إدراك لأهمية المعرفة المفقودة وأيضا ما يتطلبه الأمر لأجل إعادة تعريف المعرفة المفقودة. لذا تهدف هذه الورقة البحثية إلى دراسة الدور الذي تقدمه إدارة المعرفة بغية تحسين أداء شركات البناء وذلك من مراجعة العلاقة بين إدارة المعرفة وتحسين أداء شركات البناء في ضوء الأدبيات المتاحة والدراسات السابقة باستخدام المنهج التحليلي الوصفي من أجل الوقوف على محورين أساسيين لأي نظام معرفي يطبق في شركات البناء وهما: العوامل الفاعلة الداعمة في أنظمة إدارة المعرفة، والثاني هو المعوقات التي تواجه تطبيق الأنظمة الحإلىة لإدارة المعرفة. اثمرت الدراسة إلى أن دعم ثقافة إدارة المعرفة ودعم الإدارة العليا لها ودعم تكنولوجيا المعلومات والتدريب المستمر للموظفين من أهم عوامل النجاح الحاسمة التي أظهرتها الدراسات الميدانية السابقة. وتختلف المعوقات باختلاف بيئة العمل ومكان الدراسة. وتم تأكيد فرضية البحث وهي أن إدارة المعرفة تحسن من أداء شركات البناء، حيث تؤثر على أداء المشروع وأداء الشركة وأداء الموظفين وأيضا الفاعلية المعرفية داخل الشركة. ويعد هذا البحث هو نواه لمتخذي القرار والعاملين على تطوير أداء شركات البناء وواضعي الإستراتيجيات ونظم المعرفة من أجل تحسين الأداء وتحقيق المطلوب من الناتج النهائي في صناعة البناء.

Key Clinical Message Atypical presentations of eumycetoma can pose a challenge in the diagnosis and treatment of the disease. Healthcare providers thorough in their differential diagnosis and investigations, even in the absence of classic symptoms, in order to improve early detection and the case management for such a neglected tropical disease. Abstract In this communication, we present a case study of an unusual presentation of eumycetoma; a fungal infection that is considered a neglected tropical disease. The patient, a 28‐year‐old male from Sudan, presented with a recurrent mass in the abdominal wall. Despite two surgeries to remove the mass, it continued to recur. Unlike typical cases of eumycetoma, this patient did not exhibit common symptoms such as painless swelling, sinuses, or grain‐containing discharge. The diagnosis was made incidentally after surgical excision of the mass. The abstract highlights the importance of recognizing uncommon presentations and maintaining a high suspicion for rare diagnoses, even in the absence of classic symptoms. Further research is needed to better understand atypical presentations of eumycetoma and improve early detection.

Key Clinical Message This case report highlights the role of Helicobacter pylori infection in the development of GBS. Healthcare providers should consider H. pylori in their differential diagnosis for patients with neurological syndromes. Astract We report the first known case of Guillain–Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H. pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource‐limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H. pylori‐inducing neurological disorders.

Key Clinical Message In endemic areas, malaria‐induced cerebellar ataxia should be suspected in patients presenting with neurological disorders including slurred speech, tremors, and a sense of imbalance and dizziness while walking. Healthcare providers should be aware to properly investigate and early detect and manage infections associated with the development of cerebellar ataxia to improve the case management and clinical outcome cost‐effectively. Abstract Here, we report the clinical manifestations, investigations, and outcomes of a patient developed delayed cerebellar ataxia following a malaria infection: an unusual complication of the disease. This report highlights the diagnostic challenges in a country endemic with several infectious diseases, yet it has a limited diagnostic and surveillance capacity.

Key Clinical Message This case presents an atypical cystic presentation of mycetoma without sinuses or discharge. Awareness of these variations is crucial for accurate diagnosis and timely intervention, highlighting the need for healthcare professionals to consider diverse manifestations of mycetoma. Abstract Mycetoma is a chronic and debilitating infectious disease characterized by localized swellings and granulomatous lesions. It primarily affects individuals in tropical and subtropical regions and is caused by certain fungi or bacteria. While mycetoma typically presents with sinuses and discharge, this case report presents a unique cystic presentation without these features. The patient, a 12‐year‐old female from Sudan, presented with a painless swelling on the dorsum of her right foot. Physical examination revealed a round, non‐tender, and fluctuant mass. Histopathological examination confirmed actinomycetoma caused by Streptomyces somaliensis. The patient was successfully treated with a combination of antibiotherapy. This atypical presentation underscores the need for healthcare professionals to consider uncommon variations of mycetoma for accurate diagnosis and management.

Summary: Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding: The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Key Clinical Message Hepatitis E virus (HEV) infection can be manifested with several neurological syndromes including GBS. Therefore, healthcare providers should consider HEV in their differential diagnosis for patients with neurological disorders. Abstract We report a case of Guillain‐Barré syndrome associated with hepatitis E virus infection. The current case‐report demonstrates diagnostic challenge to identify GBS case in a limited‐resources country like Sudan. However, HEV infection should be highly suspected in patients with neurological manifestation with high liver enzymes.

Key Clinical Message We report a case of febrile illness that was presented with mild symptoms. However, laboratory investigation confirmed a malaria and Rift Valley fever co‐infection. Healthcare providers in settings endemic with several infectious diseases should seek rolling out possibilities of other infections prior to starting treatment for achieving effective case management with less resources and better safety of patients. Abstract Here we report a case of febrile illness that confirmed to be a co‐infection of malaria and Rift Valley fever. The patient was initially diagnosed with malaria and started on treatment immediately. However, due to the lack of response to the treatment further laboratory investigations were pursued.

Background: Infections caused by multi-drug resistance (MDR) strains are potentially fatal public health issues worldwide that need pressing attention. Previous reports suggested using snake venom fractions as an effective alternative mechanism to the already available antibacterial drugs. In this study, we conducted a systematic review to analyze the bactericidal effects of snake venom phospholipases (PLA2s). Methods: From the beginning through 30 March 2022, we searched the PubMed and Embase databases in accordance with the most recent PRISMA recommendations. We also conducted a manual search to identify relevant reports to improve literature coverage. Results: A total of 24 studies were included based on the selection criteria to compile this review. Of them, 16 studies were obtained from the abovementioned databases and eight through manual searches. The other 8 studies were obtained through the references of the included studies. According to the review, we reported that some PLA2s showed more vigorous bactericidal activity on some Gram-negative and a moderate effect on Gram-negative and Gram-positive. Furthermore, we reported that the presence of p-bromophenacyl bromide (p-BPP) showed a significant decrease in enzymatic and associated antibacterial activities. Moreover, we observed that about 80% of the PLA2s reported in our systematic review study were those from the Viperidae family, whereas 20% came from the Elapidae family. Moreover, some variations were revealed in the current study regarding the mechanism of actions of the snake venom PLA2s (svPLA2s). Conclusion: This systematic review provides a comprehensive overview of the bactericidal effect of snake venom PLA2s and the analysis of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of PLA2s for bacterial strains. Varying bactericidal effects from various snake species and South American rattlesnakes were reported, presenting compelling concepts to the alternative search for therapies against bacterial resistance. Thus, further analysis of the bactericidal effects of other snake venoms PLA2s considering different strains is needed. Moreover, more data are needed to investigate other bacteria of public health priority using peptides and other purified snake toxins.

Abstract Aim To investigate the feasibility of applying small vascular surgical clips as tissue markers for breast cancer in patients scheduled for neoadjuvant chemotherapy (NAC) in comparison with the dedicated breast clips with assessment of their different complications. Patients and methods This prospective randomized controlled trial included 160 female patients with breast cancer whose neoadjuvant chemotherapy was required for their management. Patients were randomly allocated into 2 groups; group I for patients who were subjected to the insertion of the small vascular surgical clips, and Group II for patients who were subjected to the insertion of the dedicated breast clips (UltraClips®). Assessment of the feasibility of the application of the vascular surgical clips and detection of the complications of the vascular surgical clips compared to the UltraClip® commercial clips were the endpoints of this study. Results Vascular surgical clips application had significantly longer duration than the duration of application of the UltraClips® (9.10 ± 2.67 min, and 5.44 ± 1.09 min respectively, P

This research focuses on metal additive manufacturing (MAM) and examines the impact of alloying materials on the anodized produced layer, placing particular emphasis on its use in the construction of the NARSSCube satellite's frame. To enhance the AA6061-T6 Al alloy's mechanical and physical qualities, Mg, Mn, Si, and Cr concentrations were changed. As a result, seven different alloys were cast, and their mechanical and physical characteristics were assessed. It is essential to anodize aluminum alloy AA6061-T6 in H2SO4 solution in order to produce an aluminum oxide film (AOF) that increases corrosion and wear resistance. This study looked into how the chemical composition of the AA6061-T6 aluminum alloy, particularly Mn, affected the production of the nano hard aluminum oxide film (NHAOF) at fixed anodization conditions of 4 °C and 20 V. Calculations were made on the thickness variation at various operating voltages throughout the anodizing process. The differences in NHAOF thickness were investigated using optical and scanning electron microscopes. Finally, anodizing the alloy with low Mn Wt.% (0.005 wt% S6) at 4 °C, 20 V, and a duration period of 120 min in a 10 % H2SO4 solution produced the oxide coating with the highest thickness (53 μm) and high-performance attributes. An increase in the hardness ratio, resistance to plastic indentation, and elastic recovery are all results of the surface's harder (5.86 Gpa) than the un-anodized sample's (1.18 Gpa) surface.

Summary: Background: The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019. Methods: The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs). Findings: While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6–35.2) and 23.4% (15.9–31.5) over 1990–2019, respectively, high-BMI with 5.1% (−9.0–25.9) and high-FPG with 21.4% (7.0–37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9–39.0) and 25.2% (16.8–33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (−6.5–28.8) and high-FPG with 27.0% (14.3–40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8–103.3), 76.0% (58.9–99.3), 10.4% (3.8–18.0), and 5.5% (4.3–7.1), respectively. Interpretation: The burden attributed to high-SBP and high-LDL decreased during the 1990–2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors. Funding: Bill & Melinda Gates Foundation.

Abstract Malaria is a serious threat to global health, with over $$95\%$$ 95 % of the cases reported in 2020 by the World Health Organization in African countries, including Sudan. Sudan is a low-income country with a limited healthcare system and a substantial burden of malaria. The epidemiology of malaria in Sudan is rapidly changing due to factors including the rapidly developing resistance to drugs and insecticides among the parasites and vectors, respectively; the growing population living in humanitarian settings due to political instability; and the recent emergence of Anopheles stephensi in the country. These factors contribute to changes in the distribution of the parasites species as well as malaria vectors in Sudan, and the shifting patterns of malaria epidemiology underscore the need for investment in improved situational awareness, early preparedness, and a national prevention and control strategy that is updated, evidence based, and proactive. A key component of this strategy is accurate, high-resolution endemicity maps of species-specific malaria. Here, we present a spatiotemporal Bayesian model, developed in collaboration with the Sudanese Ministry of Health, that predicts a fine-scale (1 km $$\times $$ × 1 km) clinical incidence and seasonality profiles for Plasmodium falciparum and Plasmodium vivax across the country. We use monthly malaria case counts for both species collected via routine surveillance between January 2017 and December 2019, as well as a suite of high-resolution environmental covariates to inform our predictions. These epidemiological maps provide a useful resource for strategic planning and cost-effective implementation of malaria interventions, thus informing policymakers in Sudan to achieve success in malaria control and elimination.

Key Clinical Message In a resource‐limited setting such as Sudan, where diagnostic and surveillance capacities are limited and several dermal diseases with similar clinical presentation are endemic, further precautious must taking into account. Abstract Cutaneous tuberculosis (CTB) is a rare infection caused by Mycobacterium tuberculosis. Atypical clinical presentations of CTB may resemble other skin neglected diseases. For definitive diagnosis, we require a holistic diagnostic approach including clinical examination and deployment of laboratory investigations including microbial culture, histopathological, and molecular examinations of the proper samples per test. In this communication, we report a case of CTB that was initially misidentified clinically as mycetoma.

Background: Cervical cancer is considered the third leading cause of death among women worldwide, and human papillomavirus was identified as a major causative agent for developing cervical cancer. Objectives: This study aimed to assess the knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan. Design: A community-based cross-sectional study implemented in Khartoum state, Sudan, from 1 August 2020 to 1 September 2020. Methods: We conducted a descriptive cross-sectional community-based study using an electronic questionnaire for data collection. Descriptive statistics, frequency, mean, and percentage were computed. Results: The study included 716 female participants with a mean age of 27.6 + 8.7 years. 580 (81.0%) and 229 (32.0%) had heard about cervical cancer and Pap test, respectively. cervical cancer was assumed related to alcohol consumption 109 (15.2%), giving birth to many children 51 (7.1%), ageing 118 (16.5%), and having many sexual partners 335 (46.8%). In addition, 300 (41.9%) attributed cervical cancer to having human papillomavirus infection, 256 (35.6%) to the prolonged use of contraceptives, and 162 (22.6%) to smoking. Knowledge about the best time to be vaccinated against human papillomavirus, 110 (15.4%) stated it is better after marriage. Regression models to predict the effectors on participants’ knowledge and attitudes showed a low standard deviation of the estimates with higher values of the adjusted R 2 [R: 0.041, 0.017, and 0.006; std: 1.527, 0.417, and 0.426]. This indicates the combined influence of occupation, educational level, family income, and marital status on the participant’s knowledge and attitude levels. Conclusion: This study revealed that the participant’s knowledge and attitudes levels are mainly driven by their occupation, educational level, family income, and marital status altogether. This underscores the need for a countrywide community engagement campaign through health education and raising awareness sessions, and massive social media to sensitize the community and healthcare providers about the risk of cervical cancer and the available prevention and control measures.

Abstract Background Malaria is a life-threatening public health problem globally with particularly heavy burden in the sub-Saharan Africa including Sudan. The understanding of feeding preference of malaria vectors on different hosts is a major challenge for hindering the transmission cycle of malaria. In this study, blood meals taken by blood-fed Anopheles mosquitoes collected from the field in malaria endemic areas of Sudan were analysed for source of blood meal and malaria parasite presence. Methods Anopheles mosquitoes were collected from different regions in Sudan: Khartoum state, Sennar state, Northern state, and El Gedarif state between September 2020 and February 2021. Anopheles mosquitoes were collected using the standard pyrethrum spray catch and back-pack aspirator. Mosquito samples were sorted and morphologically identified to species level using international identification keys. Morphologically identified mosquito species were also confirmed using PCR. Genomic DNA was extracted from mosquitoes for molecular identification of blood meal source and parasite detection. The presence of Plasmodium species DNA in each mosquito sample was investigated using semi-nested PCR. Frequency of each blood meal source, Anopheles mosquito vector, and malaria parasite detected was calculated. Positivity rate of each fed female Anopheles mosquito was calculated for each species. Results A total of 2132 Anopheles mosquitoes were collected. 571 (26.8%) were males and 1561 (73.2%) were females classified based on their abdominal status into 1048 (67.1%) gravid, 274 (17.6%) fed, and 239 (15.3%) unfed females. Among the blood fed Anopheles mosquitoes, 263 (96.0%) were morphologically identified and confirmed using PCR to Anopheles arabiensis, 9 (3.3%) to Anopheles stephensi, and 2 (0.7%) to Anopheles rufipes. Of 274 blood-fed An. arabiensis, 68 (25.9%) fed on mixed blood meals from human and cattle, 8 (3.0%) fed on cattle and goat, and 13 (4.8%) fed on human, cattle and goat. For single blood meal sources, 70 (26.6%) fed on human, 95 (36.1%) fed on cattle, 8 (3.0%) fed on goat, and 1 (0.4%) fed on dog. While An. rufipes and An. stephensi fed on dog (2; 0.75%) and cattle (9; 3.3%), respectively. Plasmodium parasite detection in the blood meals showed that 25/274 (9.1%) An. arabiensis meals were positive for Plasmodium vivax and 19/274 (6.9%) An. arabiensis meals were positive for Plasmodium falciparum. The rate of positivity of An. arabiensis with any Plasmodium species was 16.7%. However, the positivity rate with P. falciparum only was 7.2%, while P. vivax was 9.5%. Both An. rufipes and An. stephensi were having positivity rates of 0.0% each. Conclusions This study which was mainly on blood-fed Anopheles mosquitoes showed a diversity in the type of diet from human, cattle, and goat. Anopheles mosquitoes especially An. arabiensis in Sudan, are opportunistic blood feeders and can feed broadly on both human and cattle. The application of blood meal identification is not only important in malaria vector epidemiological surveillance but also is very useful in areas where arthropods exhibit zoophilic feeding behaviour for mammals.

Background: Orf is a highly contagious viral skin disease in sheep and goats caused by Orf virus (ORFV) in the genus Parapoxvirus. Although sheep and goats are considered an essential food resource, particularly in Africa, ORFV infection represents an increasing challenge to animal productivity causing high economic losses. Aim: This study aimed to detect and characterize the ORFV in suspected clinically diseased goats in two neighboring Egyptian governorates, Al-Sharkia and Ismailia, flocks during April 2020 and July 2021by using PCR and phylogenetic analysis of partial B2L sequence. Methods: Kids from two Egyptian governorates showed the clinical picture of ORFV infection. Samples were collected (n = 15) from two different flocks during April 2020 and July 2021. PCR was carried out to detect the ORFV by targeting a highly conserved sequence within ORFV (B2L) gene. To determine the phylogenetic relationship with other ORFV strains, sequencing and phylogenetic analysis were performed. Results: ORFV infection was confirmed in 12 samples of oral scabs (80%) by PCR targeting a highly conserved sequence within B2L gene. Sequencing of DNA products was performed and obtained sequences revealed 100% identity at the nucleotide level. Two ORFVs, one from each outbreak showed 98.2% nucleotide identity with a previous Egyptian ORFV (KP984529) whereas our isolates showed higher nucleotide identities, 99.1% and 98.7% with ORFV strains from neighboring countries, Sudan and Ethiopia, respectively. The phylogenetic tree grouped isolates into two main clusters, cluster I included isolates of this study and foreign ones mainly from China, India, and Sudan. Interestingly, the vaccine strains of ORF used in different countries were grouped in cluster II with previous Egyptian isolate (KP984529), Ethiopian and Israeli ORFV isolates. Conclusion: Molecular characterization of B2L gene of ORFV isolates revealed higher sequence identities and more close genetic relationships with other ORFV strains circulating in neighboring countries than with the Egyptian isolates. These findings provide an insight into the genetic diversity of field ORFV isolates circulating in goats in the Egyptian governorates.

Background: Primary coronary slow flow phenomenon (PCSFP) is a clinical entity that causes attacks of mild to severe chest pain. It is characterized by delayed coronary vessel opacification in the absence of epicardial stenosis. This work aimed for the assessment of predictors, clinical presentation, and angiographic profile of PCSFP. Subjects and Methods: This cross-sectional case–control study was done between February 2019 and January 2020, including 150 patients who presented by ST-segment myocardial infarction, non-ST segment myocardial infarction, unstable angina, chronic coronary syndrome, or atypical chest pain. The patients were divided into two groups: group 1: consisted of 100 patients who had PCSFP and Group 2: consisted of 50 patients who had normal coronary flow (NCF). Results: PCSFP was significantly more prevalent in young male patients. Among the traditional risk factors, there was significantly more prevalence of hypertension (63.0% vs. 28.0%, P = 0.001), obesity (body mass index ≥30 kg/m2 (47.0% vs. 4.0%, P = 0.001), and history of smoking (66.0% vs. 40.0%, P < 0.002) in PCSFP patients as compared to NCF patients. Triglyceride (TG), cholesterol, low-density lipoprotein, high-sensitivity C-reactive protein (hs-CRP), and hemoglobin all were higher in patients with PCSFP. Low high-density lipoprotein levels were associated with PCSFP. In multivariable analysis, PCSFP was significantly independently associated with male sex, high TG, cholesterol, and hs-CRP. TG (odds ratio [OR]: 14.427, 95% confidence interval [CI]: 3.514–59.226) and cholesterol (OR: 11.739, 95% CI, 2.439–56.513) are the strongest independent predictors for PCSFP. Conclusion: PCSFP is more common in young smoker males, is associated with hypertension, obesity, high hs-CRP, TG, and cholesterol levels. High cholesterol and TG and male sex are the strongest risk factors for PCSFP. Furthermore, inflammation plays an important factor in the pathogenesis of PCSFP due to the association of high hs-CRP level in those patients.

Abstract In this communication, we reported a series of six patients presented with Guillain‐Barré syndrome that associated with COVID‐19 infection, which was confirmed with RT‐PCR. Here we discuss the laboratory investigation and case management, as well as clinical presentation and outcome of each case. The current report demonstrated the first case series of COVID‐19‐associated GBS‐cases in Sudan.

Cutaneous larva migrans (CLM) is a self-limiting dermatosis parasitic disease that is caused by zoonotic hookworm mainly infects cats, dogs, and accidentally humans. The disease affects hosts through the invasion and the migration of the hookworm larva into top layers of the skin. The disease occurs in tropical and subtropical regions; where people commonly are infected when sitting or barefoot walking on places contaminated with feces of infected cats or dogs. Due to self-limiting nature of the disease, the exact burden and prevalence are commonly underestimated. In this communication, we investigated all cases presented to the skin-diseases outpatient clinic’ at the reference hospital of Tropical Diseases Medicine in Khartoum state between January 2019 and January 2021. This is the first-ever a case series report of cutaneous larva migrans in Sudan. We identified 15 cases of CLM presented with rash (100 %), redness of skin (67 %), and only adults were presented with larva crawling under their skins (27 %). Infection sites were (53 %) leg, (40 %) foot, only 7 % showed abdominal infection. The majority of patients were children or young adults, 47 % of them are ≤5 year-old, male to female ratio is 2.75:1. Duration of infection was one to three weeks and all patients fully recovered after treatment with albendazole. This urges for One Health interventions including deworming cats and dogs, improving water, sanitation, and hygiene, community-engagement and raising awareness in area with risk of infection.

Construction and demolition waste (CDW) is a critical challenge facing the construction industry. It leads to deterioration of the triple bottom line of sustainability. Unfortunately, the CDW management research in Egypt lacks studies investigating (1) the variations in CDW generation (CDWG) among different types of construction projects, and (2) the factors affecting CDW reduction (CDWR). Based on a benchmarking approach, this research (1) quantifies CDW in terms of generation rates and costs among different construction project types in Egypt, and (2) investigates the relationship between CDWG and different adopted CDWR factors. Using structured interviews, a comparative case study was conducted to investigate industrial, residential, commercial, and infrastructure projects. Analysis of results demonstrated that CDWG rates and costs differ from one project type to another due to the project's nature, size, and complexity on the one hand, and the applied CDWR factors such as waste-efficient practices, awareness, culture & behaviour, and legislation on the other hand. On average among the four project types, it was found that “timber”, “sand”, and “bricks/blocks” are the most wasteful materials. It was also found that “practices” and “legislation” are the least applied CDWR factors on average among the four project types, which need to be better applied for better CDWR results.

May-Thurner syndrome commonly presents with left leg swelling. Right-sided venous compression syndromes are rare. We report a 49-year-old gentleman who presented with right lower extremity swelling after leg trauma. He was found to have right distal common iliac vein compression by the overlying right internal iliac artery. He was treated with an endovascular approach with balloon venoplasty and stenting. This is a unique presentation of May-Thurner syndrome variation affecting the right lower extremity with limited description in the literature.

We report hepatitis E virus (HEV) outbreaks among refugees from Ethiopia in Sudan during June 2021–February 2022. We identified 1,589 cases of acute jaundice syndrome and used PCR to confirm HEV infection in 64% of cases. Implementing vaccination, water, sanitation, and hygiene programs might reduce HEV outbreak risk.

Venous leg ulcers (VLUs) are lesions of the skin found in regions of venous hypertension. VLUs that fail to heal can become chronic, especially because of calcified deposits in the bed of the ulcer. The unclear mechanism behind the cause of calcification poses a challenge when approaching diagnosis and management. In the present report, we discuss the case of a 58-year-old woman who had presented with a chronic VLU that was resistant to healing despite numerous interventions. During a 3-year period, a multidisciplinary team was involved to provide medical and surgical care. Eventually, she was found to have dystrophic calcification of the VLU.

Abstract Background The currently used malaria vaccine, RTS,S, is designed based on the Plasmodium falciparum circumsporozoite protein (PfCSP). The pfcsp gene, besides having different polymorphic patterns, can vary between P. falciparum isolates due to geographical origin and host immune response. Such aspects are essential when considering the deployment of the RTS,S vaccine in a certain region. Therefore, this study assessed the genetic diversity of P. falciparum in Sudan based on the pfcsp gene by investigating the diversity at the N-terminal, central repeat, and the C-terminal regions. Methods A cross-sectional molecular study was conducted; P. falciparum isolates were collected from different health centres in Khartoum State between January and December 2019. During the study period, a total of 261 febrile patients were recruited. Malaria diagnosis was made by expert microscopists using Giemsa-stained thick and thin blood films. DNA samples were examined by the semi-nested polymerase chain reaction (PCR). Single clonal infection of the confirmed P. falciparum cases, were used to amplify the pfcsp gene. The amplified amplicons of pfcsp have been sequenced using the Sanger dideoxy method. The obtained sequences of pfcsp nucleotide diversity parameters including the numbers of haplotypes (Hap), haplotypes diversity (Hapd), the average number of nucleotide differences between two sequences (p), and the numbers of segregating sites (S) were obtained. The haplotype networks were constructed using the online tcsBU software. Natural selection theory was also tested on pfcsp using Fuand Li’s D, Fuand Li’s F statistics, and Tajima’s D test using DnaSP. Results In comparison with the different pfcsp reference strains, the Sudanese isolates showed high similarity with other African isolates. The results of the N-terminal region showed the presence of 2 different haplotypes with a Hapd of 0.425 ± 0.00727. The presence of the unique insertion of NNNGDNGREGKDEDKRDGNN was reported. The KLKQP motif was conserved in all the studied isolates. At the central repeat region, 11 haplotypes were seen with a Hapd of 0.779 ± 0.00097. The analysis of the genetic diversity in the C-terminal region showed the presence of 10 haplotypes with a Hapd of 0.457 ± 0.073. Several non-synonymous amino acids changes were also seen at the Th2R and the Th3R T-cell epitope regions including T317K, E317K, Q318E, K321N, I322K, T322K, R322K, K324Q, I327L, G352N, S354P, R355K, N356D, Q357E, and E361A. Conclusions In this study, the results indicated a high conservation at the pfcsp gene. This may further contribute in understanding the genetic polymorphisms of P. falciparum prior to the deployment of the RTS,S vaccine in Sudan.

Mycetoma is a neglected tropical disease that is associated with poor communities and socioeconomically impaired individuals in the tropical and sub-tropical areas. Interestingly, the disease is caused by either bacteria (actinomycetoma) or fungus (eumycetoma). The latter form of the disease, eumycetoma, is the most common type in Africa. Eumycetoma is characterized by a prolonged disease duration and low cure rate. The effective case management of eumycetoma largely depends on the accurate diagnosis and identification of the causative agent to the species level and evaluating its susceptibility to the available drugs. This review summarizes the currently available and used antifungal agents for the treatment of eumycetoma and discusses optimizing the newly developed antifungals as a potential second line for eumycetoma treatment.

Abstract The emergence of the Asian invasive malaria vector, Anopheles stephensi, has been identified in Khartoum, the capital city of Sudan. This is the first report that confirms the geographical expansion of this urban mosquito into Central Sudan. We urgently recommend the launch of a national entomological survey to determine the distribution of this invasive disease vector and to generate essential information about its bionomics and susceptibility to available malaria control measures. Graphical Abstract

Background: Bronchial asthma is the most prevalent illness among children and teenagers. It is considered a major cause of morbidity. The physical, social, and psychological domains of childhood asthma are all affected.Aim of the work: To measure the pediatric asthma quality of life [PAQOL] levels within asthmatic children and its main predictors in Damietta, Egypt.Methods: An analytical cross-sectional survey was carried out utilizing a questionnaire that assesses [PAQOL] levels with related socio-demographic factors and asthma control levels. Asthma control level was tested by an asthma control test questionnaire. PAQLQ as a dependent variable and other plausible independent variables were analyzed by a stepwise linear regression model.Results: Two hundred participants, aged 7–17 years were included; [56%] were females, [30.5%] residing in urban areas, and [77%] had belonged to middle and low socioeconomic classes. Gastro-esophageal reflux [GER] was shown to have a significant positive correlation with allergic rhinitis [P< 0.01] and obesity [P< 0.01]. Otherwise, GER was shown to be negatively correlated with asthma control status [P< 0.01]. Mean ± standard deviation [SD] of overall, activity and Emotion domains scores of QOL were 4.51± 1.3, 4.52± 1.25, and 4.54± 1.39 respectively. While more than 50% of the symptoms domain scores were more than 4.7. Low socioeconomic level [P< 0.01], poor asthma control [P< 0.01], and positive history for controller medications [P< 0.05] were significant predictors for lower asthmatic children's quality of life.Conclusion: Asthmatic children tend to have a poorer quality of life. To provide effective asthma treatment to the general public, prescribers and patients must both understand and be educated. Healthcare providers should consider PAQOL with greater attention to children with poor socio-economic standards and uncontrolled asthma in the management plan.

PurposeThis study aims to investigate the impact of perceived service quality (PSQ) on tourist satisfaction and behavioral intentions and explore the potential mediating role of tourist satisfaction in the relationship between service quality and behavioral intentions in the yoga tourism context during the COVID-19 pandemic. Further, this is to examine to what extent yoga tourist satisfaction directly affects their behavioral intentions.Design/methodology/approachBased on a review of literature, the study proposes a conceptual model to test four hypothesized relationships among the constructs of perceived service quality, tourist satisfaction, and behavioral intentions. Data was collected by using a self-administrated questionnaire that was developed and directed to a convenience sample of yoga tourists (380 forms). Structural equation modeling (SEM) was employed to determine the relationship between study constructs.FindingsThe results of SEM illustrated that all the hypothesized relationships are supported. The findings confirm that yoga tourists’ behavioral intentions are significantly affected directly and indirectly (through tourist satisfaction) by perceived service quality. Additionally, tourist satisfaction significantly partially mediates the relationship between PSQ and tourists’ behavioral intentions.Research limitationsThe subject of this study was yoga tourists staying in yoga retreats/studios in Egyptian destinations (South Sinai Governorate). Future research may focus on other geographical destinations and other influential variables of yoga tourists’ satisfaction and behavioral intentions should be investigated.Practical implicationsFor improving tourists’ satisfaction and behavioral intentions, yoga service providers should take care by giving tourists personalized attention, and understanding, fulfilling their specific needs. Health and hygiene practices must be considered during the COVID-19 pandemic.Originality/valueThis study is perhaps the first empirical study that examines the relationship between PSQ and tourists’ satisfaction and behavioral intentions in the yoga tourism context. A new integrated conceptual model that combined three service quality dimensions, namely, tangibles, intangibles as well as health and hygiene was developed and validated.

Eumycetoma is an infectious disease caused by various fungal pathogens. The disease is characterised by black and pale-yellowish grain discharge. In this communication, we report a case of eumycetoma with a pale grain foot-eumycetoma caused by Fusarium falciforme. The patient presented at the outpatient clinic of the Mycetoma Research Centre in Sudan. The causative agent was initially misidentified as Aspergillus nidulans based on its seemingly similar histopathological appearance. However, sequencing the internally transcribed spacer region of the extracted grain confirmed infection with Fusarium falciforme. Although the patient received Itraconazole and underwent surgical excision, the disease was recurrent. To our knowledge, this is the first report on Fusarium falciforme causing eumycetoma in Sudan, indicating the expansion of the geographical distribution of this pathogen. This calls for raising the awareness of healthcare providers and improving the diagnostic and surveillance systems in at-risk areas to improve the case management and reduce the threat of further spread. Considering the potential impacts of F. falciforme infection including threatening the global health, food security, and ecosystem balance, as well as loss of biodiversity and negative socioeconomic changes in endemic countries, we recommend the implementation of an integrated transdisciplinary One Health strategy for the prevention and control of emerging infectious diseases including F. falciforme.

Our study was carried out at the farm of Faculty of Agriculture, Ain Shams University, Egypt. The average temperatures were 18.4°C and 23.9 °C from December 2017 - February 2018 to study the effects of Saccharomycescerevisiaeboulardii supplementation (as feed additives) on productive performance of growing rabbits. Sixty growing rabbits of the NZW (New Zealand White Rabbits), (4 weeks old) and weighted (603.62 gm mean body weight) were randomly distributed into 4 treated groups, n=15 rabbits per each group. Rabbits of supplemented groups were given 100 (R1), 200 (R2) and 400 (R3) gm/ton feed of Saccharomyces cerevisiaeboulardii mixed in the diet for 6 successive weeks. Individual live body weight was noted weekly from start till the end of the experiment. At the end of the experimental period, 10 rabbits (from each group) were fasting for 12 hrs, then slaughtered for carcass traits measure. Experimental lighting system was 16-hours photoperiod /day (16L: 8D) through both daily natural and the artificial fluorescent lighting. A pelleted ration of 17.3% crude protein, 13.37% crude fiber and 2510 kcal of digestible energy per kg feed was offered ad libitum all the time. Results revealed significant (P≤0.05) increases in the final body weight and daily weight gain with saccharomyces cerevisiae supplementation when compared with control group. Though, significantly (P≤0.05) improved feed conversion ratio in all treated groups compared with control one were noticed. Feed intake was the lower in treated groups than control group. There were significant (P≤0.05) increasing in hot carcass weight and carcass percentage with respect to the control group. Supplemented Saccharomycescerevisiae reduced (P≤0.05) the liver, heart, lungs and kidneys percentages compared the control group. Supplemented rabbit feeds with saccharomycescerevisiaeboulardii in their diets had highly increasing in relative economic efficiency and clear improvement of net revenue than control group.

Objectives: This study aimed to investigate an outbreak of a non-malaria, undifferentiated febrile illness, among internally displaced persons (IDPs) living in humanitarian camps in North Darfur, Sudan, in 2019. Methods: An investigation team was deployed to North Darfur to identify suspected cases and collect blood samples, and clinical and demographical data. Blood samples were examined microscopically for Plasmodium spp and tested for dengue (DENV) and yellow fever viruses by reverse transcriptase-quantitative polymerase chain reaction. Results: Between September 7 and December 18, 2019, we clinically identified 18 (24%), 41 (54%), and 17 (22%) cases of dengue fever, dengue with warning signs, and severe dengue, respectively. Blood samples were collected from 22% of patients, and 47% of these tested positive for DENV-1 RNA. We confirmed 32 malaria cases with 5 co-infections with DENV. This outbreak of dengue was the first among IDPs in the humanitarian camps. Conclusions: Our findings indicate that dengue has become endemic or that there has been a new introduction. Further epidemiological, entomological, and phylogenetic studies are needed to understand disease transmission in the area. An early warning and response system and an effective health policy are crucial for preventing and controlling arboviruses in Sudan.

Background: The treatment need is one of the fundamental factors for effective planning of postgraduate dental programs that improve the competency of dental practitioners. Aims: To assess the treatment need of patients at Umm Al-Qura University, Dental Teaching Hospital utilizing statistically representative sample of patients visiting the clinics. To use data analyzed to propose the need and design for postgraduate degrees in the college. Material and methods: Information were retrieved from the electronic database of 4,967 patients’ files anonymously including age, gender, treatment needs and referred clinic specialty. The obtained data were subjected to descriptive statistics in the form of mean ± SD, frequencies, cross tabulations, and percentages using Statistical Package for the Social Sciences (SPSS) software. Results: The percentage of females' records was significantly higher (52%) than that of males. The mean age of males was higher than females (36.66 versus 35.10) while young adult age category constituted the greatest number (36.6%). The most common treatment need recorded in patients' files were periodontics (73.3%), restorative (60.4%) followed by fixed prosthodontics (54.8%). Nearly half of the patients’ (48.9%) were in need of endodontic treatment. The common significantly higher needs in females were restorative and periodontics, while among males, significantly higher treatment needs for surgery, endodontics and prosthodontics were recorded. Conclusion: Patient treatment needs at Faculty of Dentistry, Umm Al-Qura University reflect a high priority for proposing postgraduate degrees in periodontics and restorative dentistry. Also, devoting considerable time and effort in counseling and providing undergraduates with information that guide in making career decisions and match the treatment needs in Makkah, Saudi Arabia. Clinical Significance: Establishment of dental postgraduate degrees that meet the treatment needs of the community will lead to more professional diagnosis and management of patients by qualified specialists.

Partial nephrectomy of renal allografts is technically challenging. We report a case of robotic-assisted laparoscopic partial nephrectomy performed with selective cannulation and endovascular balloon occlusion of vascular inflow to transplanted kidney. Endovascular control during partial nephrectomy in a renal allograft and review of literature.

Abstract Background In spite of the global effort to eliminate malaria, it remains the most significant vector-borne disease of humans. Plasmodium falciparum is the dominant malaria parasite in sub-Saharan Africa. However, Plasmodium vivax is becoming widely spread throughout Africa. The overuse of vector control methods has resulted in a remarkable change in the behaviour of mosquito that feeds on human as well as on vector composition. The aim of this study was to identify Anopheles mosquito species in vivax malaria endemic regions and to investigate their role in P. vivax circumsporozoite protein (Pvcsp) allele diversity. Methods Mosquito samples were collected from Central Sudan (Rural Khartoum and Sennar) and Eastern Sudan (New Halfa, Kassala state) using pyrethrum spray catch (PSC) and CDC light traps. Mosquitoes were identified using appropriate morphological identification keys and Anopheles gambiae complex were confirmed to species level using molecular analysis. A subset of blood-fed anopheline mosquitoes were dissected to determine the presence of natural infection of malaria parasites. In addition, the rest of the samples were investigated for the presence of Pvcsp gene using nested-PCR. Results A total of 1037 adult anopheline mosquitoes were collected from New Halfa (N = 467), Rural Khartoum (N = 132), and Sennar (N = 438). Morphological and molecular identification of the collected mosquitoes revealed the presence of Anopheles arabiensis (94.2%), Anopheles funestus (0.5%), and Anopheles pharoensis (5.4%). None of the dissected mosquitoes (N = 108) showed to be infected with malaria parasite. Overall P. vivax infectivity rate was 6.1% (63/1037) by Pvcsp nested PCR. Co-dominance of An. arabiensis and An. pharoensis is reported in Sennar state both being infected with P. vivax. Conclusion This study reported P. vivax infection among wild-caught anopheline mosquitoes in Central and Eastern Sudan. While An. arabiensis is the most abundant vector observed in all study areas, An. funestus was recorded for the first time in New Halfa, Eastern Sudan. The documented Anopheles species are implicated in Pvcsp allele diversity. Large-scale surveys are needed to identify the incriminated vectors of P. vivax malaria and determine their contribution in disease transmission dynamics.