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Elkhansa Hassabo Mohamed,* Dalia A Kheir* Faculty of Medicine, University of Khartoum, Khartoum, Sudan*These authors contributed equally to this workCorrespondence: Elkhansa Hassabo Mohamed, Email khansa.hsbo@gmail.comPurpose: Conflict and war can have profound psychological and physical consequences, including the displacement of civilians. Sudan currently has the greatest child displacement crisis and the highest number of displaced individuals worldwide. Stressors, such as unemployment, poor socioeconomic conditions, and lack of social integration can increase the risk of developing mental health conditions and worsen pre-existing ones. This study aims to determine the prevalence of PTSD and depression and to investigate the association of sociodemographic and displacement characteristics with both PTSD and depression.Patients and Methods: An observational descriptive cross-sectional community-based study was conducted among 143 IDPs, in Al-Galgala village, Sudan. The data was collected by seven, well-trained individuals over 2 weeks. The PTSD Checklist – Civilian version (PCL-C) scale was used for PTSD symptoms, and the Patient Health Questionnaire 9 (PHQ-9) scale was used for depression symptoms. The diagnostic criteria for PTSD and depression symptoms were based on the Diagnostic and Statistical Manual (DSM-IV). Descriptive statistics and Binary Logistic Regression analysis were adopted to determine the predictors for PTSD and depression symptoms. A P-value of 0.05 or lower was considered statistically significant.Results: The prevalence of PTSD symptoms was found to be 25% based on DSM-IV symptoms’ criteria and that of depression was 62%. Moreover, 23.1% of the participants had comorbid depression and PTSD symptoms. Being female (AOR = 8.434, 95% CI [1.026– 69.325]), and having depression increased the risk of developing PTSD (AOR = 45.631, 95% CI [7.125– 292.232]). Whereas, being older (40– 59 years) (AOR = 6.473, 95% CI [1.054– 39.766]) and having PTSD (AOR = 24.736, 95% CI [4.928 − 124.169]) increased the risk of developing depression.Conclusion: The estimated prevalence of PTSD and depression among IDPs in Al-Galgala, Sudan was found to be relatively high. This study revealed that depression, gender, occupation, education, and with whom you are currently staying were significantly associated with PTSD. In contrast, factors associated with depression were PTSD, age, and the duration of exposure to the armed conflict. The mental health among IDPs needs to be prioritized by implementing effective programs and providing psychosocial support to civilians residing in post-conflict regions.Keywords: PTSD, depression, internally displaced persons, armed conflict, Sudan

Khabab Abbasher Hussien Mohamed Ahmed,1 Amira Siddig,2 AlHussien Abbashar,3 Mohammed Abbasher,4 Abubaker Alsedig Abbasher,5 Abbasher Hussien,6 Gaffar Alemam A Manhal1 1Faculty of Medicine, University of Khartoum, Khartoum, Sudan; 2Department of Community Medicine, Faculty of Medicine, AlNeelain University, Khartoum, Sudan; 3AlYarmouk College, Khartoum, Sudan; 4Faculty of Medicine, AlNeelain University, Khartoum, Sudan; 5Zamzam University College, Khartoum, Sudan; 6Department of Internal Medicine and Neurology, Faculty of Medicine, University of Khartoum, Khartoum, SudanCorrespondence: Khabab Abbasher Hussien Mohamed Ahmed, Faculty of Medicine, University of Khartoum, Khartoum, 11111, Sudan, Tel +249907712134, Email khabab9722@gmail.comAbstract: Bell’s palsy is a lower motor neuron lesion rarely associated with COVID-19 infection or vaccinations. We documented two cases of Bell’s palsy in this report, one after contracting COVID-19 infection and the other after administration of AZD1222 Vaxzervria (AstraZeneca) Vaccine. After excluding all possible causes of Bell’s palsy in both cases, we determined that COVID-19 infection and the AZD1222 Vaxzervria (AstraZeneca) vaccine were the causes. Thus, we believe COVID-19 and the AZD1222 Vaxzervria (AstraZeneca) vaccine should be considered as causes of Bell’s palsy.Keywords: COVID-19, SARS-CoV-2 virus, Bell’s palsy, AZD1222 Vaxzervria (AstraZeneca) vaccine, Sudan

Galal Faisal Abdulqader Abdulla Albani,1 Widad Ibrahim Abdelgadir,2,3 Amal Abdelgadir Ali Mohamed,4 Magda Yousif,5 Amna Mohammed Ali Mustafa,6 Egbal Abbashar Algmair Almkiy,7,8 Khadiga Z M Mohammed,4,9 Eman Ahmed Saad Mohamed,7 Fahad Abdullah A Alghamdi,10 Raga Gasim Ahmed,11 Manal SA Hakami,10 Niemat A Dinar,10 Amal Alsulami,2 AbdAllah Ibrahim AbdAlrahman Mudawi,12 Waled AM Ahmed10 1Department of Nursing, Faculty of Medical Sciences, Aljanad University for Science and Technology, Taiz, Yemen; 2Department of Community Health Nursing & Mental Nursing Sciences College of Nursing,Taif university, Taif, Saudi Arabia; 3Faculty of Nursing Sciences Bahri University, Sudan; 4Department of Maternal and Child Nursing Sciences College of Nursing,Taif university, Taif, Saudi Arabia; 5Nursing Department, Prince Sultan Military College of Health Sciences, Dhahran, Saudi Arabia; 6Faculty of Nursing Sciences, Jazan University, Jazan Saudi Arabia; 7Department of Nursing, Faculty of Applied Medical Sciences, Buraydah College, Buraydah, Saudi Arabia; 8Faculty of Nursing Sciences, Alneelain University, Sudan; 9Nursing Faculty, Zagazig University, Zagazig, Egypt; 10Faculty of Nursing, Al-Baha University, Al-Baha, Saudi Arabia; 11Department of Nursing, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia; 12Oral and Dental Health Department, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi ArabiaCorrespondence: Waled AM Ahmed; Amal Abdelgadir Ali Mohamed, Tel +966508245369; +966550367392, Email wahmed@bu.edu.sa; ammohamed@tu.edu.saBackground: Oral health education programs have long been considered an essential part of oral health policies. This is important for reducing the risk of oral diseases through health enhancement and voluntary behavioral changes due to learning opportunities. This study aimed to evaluate the effects of school-based oral health education program on oral health in school children in Sudan.Methods: A quasi-experimental study was conducted at four governmental schools in Khartoum, Sudan, between August 2018, and March 2022. A total of 423 school children were randomly allocated into the control (n = 211) and study (n = 212) groups. An adapted questionnaire was administered to students before and after the intervention to assess their knowledge and practice of oral health. The study group participated in oral health education activities. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), version 21.Results: The findings revealed that the mean knowledge at the pre-educational program was 9.3066 (SD = 3.91078) and the mean knowledge after the educational program was 21.2736 (SD = 2.13982). The scores indicated that the school children had significantly higher knowledge and practice scores after the oral health education program.Conclusion: The study concluded that education program on oral health improved students’ oral health knowledge and practices. Imposing theoretical and practical lessons on oral and dental health in school curricula can motivate students to maintain oral health care, and this improves oral health status.Keywords: education program, school children, oral health, knowledge, practice, Sudan

Mohamed Elfaith Mustafa Mohamed,1,2 Ziryab Imad Taha,1,3– 5 Salih Boushra Hamza,2,5 Yassin A Abdalla,2,5 Sufian K Noor,6 Jimmy William5,7 1Rheumatology Speciality Department, Sudan Medical Specialization Board, Khartoum, Sudan; 2Department of Internal Medicine, Faculty of Medicine and Health Sciences, Omdurman Islamic University, Khartoum, Sudan; 3Department of Clinical Medicine, Medical and Cancer Research Institute (MCRI), Nyala, Sudan; 4Department of Internal Medicine, University of Bahri, Faculty of Medicine, Khartoum, Sudan; 5Rheumatology Department, Ziryab Research Group, Khartoum, Sudan; 6Department of Internal Medicine, Nile Valley University, Faculty of Medicine, Atbara, Sudan; 7General Internal Medicine Department, Sligo University Hospital, Sligo, IrelandCorrespondence: Jimmy William, Sligo University Hospital, The Mall, Rathquarter, Sligo, F91 H684, Ireland, Tel +353 851173213, Email Jimgw20@gmail.comPurpose: To evaluate vitamin D levels among adult Sudanese RA patients and identify its correlation with RA disease activity.Patients and Methods: A bicentric cross-sectional analytical hospital-based study was performed in two Khartoum State Hospitals between October 2019 and January 2020, enrolling 90 Sudanese patients with RA. Serum vitamin D levels were measured with a standard reference level of 30ng/mL– 100ng/mL. A detailed interview-based questionnaire was used to collect the patient’s information, clinical data and lab results—disease activity was assessed via the DAS-28 score. The data was then analyzed using SPSS v-24.Results: Vitamin D levels were low in 79 candidates (87.8%), 53 of which (67.1%) showed moderate insufficiency (10– 30ng/mL), and 26 candidates (32.9%) had severe deficiency (less than 10 ng/mL). Regarding the disease activity, 57 participants (63.3%) had moderate disease activity (DAS-28=3.2– 5.1), and 22 participants (24.4%) had high disease activity (DAS-28 > 5.1). A significant negative correlation was reported between high DAS-28 scores and low vitamin D levels with p-value = < 0.001 (95% CI: − 0.8591 to 0.0015) and r = − 0.44.Conclusion: Most adult Sudanese rheumatoid arthritis patients showed low vitamin D levels (87.8%), which was also significantly correlated with increased disease activity (P-value < 0.05). Moreover, the prevalence of low vitamin D levels was significantly higher than in numerous countries worldwide.Keywords: vitamin D, rheumatoid arthritis, DAS-28 score, Sudan

Ismaeil Eldooma,1,2 Maha Maatoug,2 Mirghani Yousif2 1National Health Insurance Fund. Planning, Research, and Information, Gezira State, Sudan; 2Clinical Pharmacy & Pharmacy Practice Faculty of Pharmacy, University of Gezira, Wad Medani, SudanCorrespondence: Ismaeil Eldooma, National Health Insurance Fund, Department of Planning, Research, and Information, Gezira State, Sudan, Tel +249123162135, Email esmdooma@gmail.comBackground: Pharmaceutical Care (PhC) services within community pharmacies (CPs) have become a vital issue in many developed countries.Purpose: This study assessed the availability of PhC tools and pharmacists’ views towards PhC services within CPs in Sudan.Methods: A cross-sectional study was conducted from December 2019 to August 2020 using a pretested self-administered questionnaire. The participants were 120 community pharmacists.Results: Fifty-eight percent of respondents used to work in pharmacies near homes rather than within the marketplace. The study revealed that the overall tool availability of the assessed components and items was only 25% (Counselling areas 3%, Records 5%, Pharmacist identity 3%, Pharmacy phones 15%, Medical devices 38%, and Staff 29%). The result of pharmacists’ views towards the PhC concept, roles, and responsibilities showed a high level of agreement, at 88%, with a statistically insignificant difference between participants.Conclusion: Tools available within CPs were lower than required. However, pharmacists’ views showed a high agreement level towards PhC concept roles and responsibilities. Community pharmacists, academic sectors, and regulatory authorities must start initiatives to improve the provision of PhC tools for better patient care service delivery.Keywords: community pharmacies, community pharmacists, pharmaceutical care tools, pharmacists’ views, Sudan

Fadi M Toum Ahmed,1,&ast; Mohammed Mahmmoud Fadelallah Eljack,2,&ast; Hiba Awadelkareem Osman Fadl,3– 5 Abdelrahman Hamza Abdelmoneim Hamza,6,7 Siham Abdalrhman Gsmalseed Mohammed,8 Waddah Adil Taha Muawad,9 Tarig Musa Khaleid Almahi,8 Sara Alameen Mohamed Ahmed,8 Hiba Faroug Alameen5 1Department of Internal Medicine, University of Sinnar, Sinnar, Sudan; 2Faculty of Medicine and Health Sciences, University of Bakht Alruda, Ad Duwaym, Sudan; 3Department of Haematology, Faculty of Medical Laboratory Sciences, Al-Neelain University, Khartoum, Sudan; 4Department of Medical Laboratory, Sudanese Medical Research Association, Khartoum, Sudan; 5Sudan Medical Specialization Board, Khartoum, Sudan; 6MBBS Faculty of Medicine, Al-Neelain University, Khartoum, Sudan; 7Department of Human Anatomy, University of Khartoum, Khartoum, Sudan; 8Department of internal Medicine, Sinnar Teaching Hospital, Sinnar, Sudan; 9Department of Surgery, Sinnar Teaching Hospital, Sinnar, Sudan&ast;These authors contributed equally to this workCorrespondence: Mohammed Mahmmoud Fadelallah Eljack, Community department, University of Bakht Alruda, Ad Duwaym, Sudan, Tel +249964656914, Email m.mahmmoud96@gmail.comIntroduction: Medical school curriculum evaluation is necessary to document outcomes, determine the effectiveness of educational programs, and meet accreditation requirements. This has become more difficult over the last decade, and it is critical to carefully assess the conclusion. The purpose of this research was to gather information from Sinnar medical students regarding their perceptions of the curriculum, learning, teachers, and academic self-perception.Methodology: A cross-sectional analytic quantitative study including under and freshly graduated students was conducted in the Faculty of Medicine, University of Sinnar, Sudan, between the 18th of January 2021 and the 2nd of February 2022. Data was collected using a validated questionnaire including student perception of learning, student perception of teachers, academic self-perception, and student self-perception.Results: A total of 705 students participated in this study. Of them, 443 (63.1%) were females, with the majority from second years (35.8%) followed by fourth-year (21.6%). A 433 (64.5%) agreed that the teaching is students centred, and teaching helped them in their development (68.0%). In addition, nearly half of the participants (58.1%) stated that the teacher communicated clearly and understandably. Unfortunately, 44.6% said that the exam did not achieve all the course objectives. The most tension-induced places were the dissection room (DR) accounting (70.3%) followed by lecture halls (55.6%). The most common reason for not enhancing research skills is the unavailability of the research department (72.8%), along with the stress associated with the curriculum due to a lack of enough time for different activities (63.8%). Significant differences between males and females were found when answering questions regarding research skills and students’ involvement in curriculum time management.Conclusion: Most students have a positive impression towards the local curriculum, learning, and engaged teachers. More studies with more standardization and specification regarding curriculum content, Curriculum structure and strategies, should be conducted in the future.Keywords: medical school, perceptions, accreditation, curriculum, University of Sinnar, Sudan

Saeed M Omar,1 Osama S Osman,1 Gasim I Gasim,2 Ishag Adam3 1Faculty of Medicine, Gadarif University, Gadarif, Sudan; 2Klerksdorp/Tshepong Hospital Complex, the University of Witwatersrand, Johannesburg, South Africa; 3Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi ArabiaCorrespondence: Ishag Adam, Email ishagadam@hotmail.comPurpose: Sub-Saharan Africa suffers from a dual impact of communicable (CDs) and non-communicable diseases (NCDs). There is scarce data on causes, trends of admission, and deaths among patients in Sudan. We aimed to determine the causes, trends of admission, and mortality among adult patients admitted to Gadarif Hospital in Eastern Sudan.Patients and Methods: The medical records of adult patients admitted to Gadarif medical wards from January 2017 to December 2020 were reviewed for age, gender, causes of admission, and outcomes. Multivariate Cox regression analysis was used to analysis factors (age, sex, years, and disease) associated with the mortality.Results: Of the 7230 patients who were admitted, 2221 (34.7%) were females and 5009 (69.3%) were males. The median age (interquartile range, IQR) was 47.0 (35.0) years. Of these 7230 patients, 3167 (43.8%) and 4063 (56.2%) patients were admitted with CDs and NCDs, respectively. Cardiovascular diseases (18.4%), snakebites (12.9%), and visceral leishmaniasis (12.0%) were the most common causes of admission. The overall in-patient adult deaths were 674 (9.3%). Cardiovascular diseases (22.3%), neurological diseases (16.9%), sepsis (15.9%), renal diseases (13.9%), and snakebites (8.3%) were the most common causes of inpatient mortality. Malignancy (20.7%), sepsis (20.9%), neurological diseases (17.4%), and cardiovascular diseases (13.8%) comprised the highest case fatality rates among the admitted patients. Using a Cox regression model (adjusted), age (adjusted hazard ratio = 1.02, 95% confidence interval = 1.01‒1.03) was associated with increased mortality hazard. However, the gender and years of admission were not associated with increased mortality hazard.Conclusion: Admissions and mortality rates for CDs and NCDs are high compared with other African countries. Preventive measures are required to avert the high burden of these diseases. Health care systems in Sudan need to be prepared to deal with the dual burden of the diseases.Keywords: communicable diseases, cardiovascular diseases, mortality, Sudan

The study aimed to identify the attitudes of teaching staff members at the University of Bakht Al-Ruda towards research and teaching from their perspective, and to investigate if there are statistically significant differences between the means of the study participants due to the variables of gender (male, female) and academic rank (associate professor, assistant professor). To achieve this, the descriptive method was adopted and a questionnaire was developed and administered to a sample of (65) teaching staff members who were randomly selected. The final version of the questionnaire consisted of 17 items on teachers’ attitudes towards research and teaching. The study results revealed that teaching staff members’ attitude towards research and teaching at the University of Bakht Al-Ruda was medium, and there were no significant differences in the means of their responses due to gender (male, female), and academic rank (associate professor, assistant professor). The study concluded with a number of recommendations, including that the university administration should provide sufficient financial support for research by providing tools, equipment, laboratories and libraries to encourage research.

Study area is located in the eastern sector of Saharan Meta - Craton that includes the western part of Bayuda Terrane and extend southwest to Sodri - Um Badir shear zones. The sector is dominated by metasediments, metavolcanic - sedimentary series represented by chlorite - schist, quartzite, calc - silicate, and marble. Low - grade metamorphic arc - related volcano - sedimentary sequence occurs as thin narrow bands and subjected to tectono - thermal events of Pan - African orogeny during the Late - Proterozoic era (900 - 550 Ma). All these rock sequences have been intruded by syn to Late Orogenic Granitoids and post - orogenic ring - shaped complex and felsic dykes. The intrusions are thought to be the source of hydrothermal fluids that caused the precipitation of gold. Similar characteristics of geological features and tectonic settings support the possibility of the extension of gold mineralization between shear zones. The comparison between the three gold mineralizations reveals variations in minerals assemblages, pathfinders and gold grade. The result of this study defines a new metallogenic province in the west of the River Nile, which occupies a very large area covered by Phanerozoic sediments. Numerous mineral deposits of economic potentiality have been targeted along the shear zones and related fractures and faults. Among those potential deposits, five of them have been chosen as targets for future gold exploration and evaluation.

The study aims to explore the barriers of online learning in Sudan. The achievement of the research purpose requires an approach which is not only describes the relations between variables, but also the experience of the stakeholders, therefore, the study adopted mixed mothed approach. To collect data, the study used two sources; secondary, and primary data sources. The secondary sources included peer-review international journals from recognized publishers, books, newspapers and reports. The primary sources included questionnaires and interviews. 132 participants were surveyed. Two professors were interviewed. SPSS was used to analyze the data. The findings indicate that there are five unique barriers to e-learning adoption in Sudan including; poor network infrastructure, lack of bandwidth in rural areas, electricity outages, lack of electricity in rural areas, and stakeholder’s deficiency of e-skills. Furthermore, the study showed that some professors are old, and they resist the adoption of e-learning. Likewise, the study found that 67% of respondents were not able to access the internet in their areas during Covid19 lockdown, 25% of respondents do not possess computers, 35% of respondents did not receive training for gaining E-skills, and 74% of respondents prefer learning in classrooms. The study concluded that, E-learning to be adopted in Sudan, several steps can be taken such as e-skills intensive training for stakeholders, support of stakeholders, electricity and internet networks connection to whole parts of Sudan, poverty combat, and stimulation of students to accept e-learning.

Background: Patient satisfaction is an important measure of health service and a key indicator of the quality of health service. Studies focus on how to improve quality rather than patient satisfaction. This study was conducted to identify patients’ satisfaction with the pharmaceutical service package of Health Insurance Corporation of Khartoum State in Jabal-Awliya locality, Khartoum, Sudan. Methods: A cross-sectional study was conducted between January and August 2020. Data were collected using a structured questionnaire. Satisfaction was estimated using the Likert Scale. The association between patient’s satisfaction and patient care indicators, namely: average dispensing time, percentage of medicine dispensed and labelled, and patient correct dose knowledge were assessed using Chi- square test, where a p-value < 0.05 was considered significant. Results: Out of 378 participants, the mean age was 47 with a comparable frequency of male and female participants (49.3% and 50.7% respectively). The mean satisfaction was 62.2% (3.11 ± 0.68). Most of the participants were satisfied with the way the pharmacist dealt with them (3.7, ± 0.778), while a low mean of satisfaction was reported regarding the availability of medicine within the pharmaceutical benefit package (2.06, ± 1.17). Average dispensing time was 5.78 minutes (p = 0.002), a low percentage of medicine actually dispensed and labelled was observed at 67% and 58% respectively (p = 0.00). A higher patient knowledge was reported 96.6% (p = 0.00), and the majority of the patients were able to pay 65% (p = 0.00). Conclusion: The current study demonstrates a comparable satisfaction score. However, medication unavailability is the main factor that affects patient satisfaction.

Introduction: Fine-needle aspiration (FNA) cytology biopsy of the thyroid gland is an accurate and useful diagnostic tool in the initial evaluation of nodular thyroid lesions. We aimed in this study to determine the cytomorphological patterns of thyroid lesions diagnosed by FNA among Sudanese patients. Methods: A descriptive retrospective, clinic-based study was performed. Cytopathological records of patients that attended the Total Lab Care Clinic in Khartoum-Sudan between January 2016 and December 2017 were reviewed. Results: A total of 1646 patients records were reviewed; 1385 (84.1%) were females and 261 (15.9%) males. A total of 1563 (94.9%) were negative for malignancy, 39 (2.4%) were positive for malignancy, 42 (2.6%) were indeterminate for malignancy and 2 (0.1%) were non-diagnostic. Colloid goiter was seen in 1147 patients (73.4%), benign hemorrhagic cysts were seen in 257, Hashimoto thyroiditis was seen in 77, benign thyroid nodules were seen in 76, keratocysts were seen in 2, thyroglossal duct cysts were seen in 2, thyroid follicular adenoma was seen in 1 and myxedema was seen in 1. For malignant patients; 11 had anaplastic thyroid cancer, 8 had papillary thyroid cancer, 7 had follicular thyroid cancer, 5 had metastatic thyroid cancer, 4 had medullary thyroid cancer, 3 had non-Hodgkin lymphoma and 1 had thyroid follicular adenoma. For those indeterminate for malignancy, 24 had follicular neoplasm and 18 had Hurthle cell neoplasm. Conclusions: Fine needle aspiration cytology for thyroid nodules provides a rapid and non-invasive technique for the evaluation and differentiation between benign and malignant lesions. This study also addresses the increased predominance of benign thyroid lesions among young patients and thyroid malignancy among the 4th decade of life.

Background: Human cytomegalovirus (HCMV) is a major cause of congenital infections. It is more widespread in developing countries and communities with low socioeconomic status. The infection can cause pregnancy loss or spontaneous abortion. Tests are available for the detection of HCMV IgG and IgM antibodies. Many pregnant women in Blue Nile State, Sudan, have suffered from recurrent pregnancy loss, and currently there is no available data concerning the prevalence of HCMV in Blue Nile state. This study aimed to determine HCMV antibodies (IgG and IgM) among pregnant women, who had undergone abortion(s), attending El-Damazin Hospital for Obstetrics and Gynecology. Methods: This was a descriptive, cross-sectional hospital-based study. 270 pregnant women, who had undergone abortion(s) and who attended El-Damazin Hospital for Obstetrics and Gynecology, were included in the study from September to December 2018. Personal and clinical data were collected directly from each participant into a predesigned questionnaire. Serum samples were separated and stored at -20˚C until used. Samples were analyzed for HCMV IgG and IgM using enzyme-linked immune-sorbent assay (ELISA). Results: Participants were categorized into three age groups: 15-25 years (33.7%; 91/270); 26-40 years (62.2%; 168/270); and >41 years (4.1%; 11/270). The majority of the participants had IgG antibodies to HCMV (74.8%; 202/270), while only 13.3% (36/270) had IgM antibodies to HCMV. Most abortion cases were documented in the first trimester (85.6%; 231/270) and this had a significant relationship with IgG level (P=0.003). Low socioeconomic status was recorded in 84.8% (229/270) of participants and showed significant correlation with IgG level (P=0.025), whereas illiteracy was reported in 41.9% (113/270) of participants and did not have a significant relationship. Conclusions: Seroprevalence of HCMV in this study population was 74.8% for IgG antibodies. There was an association between HCMV IgG level and first trimester abortion and low socioeconomic status among the studied women.

Background: The protein product of the normal TP53 gene performs an essential function in cell cycle control and tumor suppression, and the mutation of a TP53 gene is an essential step in the development of many cancers. Despite the reported association of TP53 gene mutations with many human cancers, the comprehensive computational analysis of single nucleotide polymorphisms (SNPs), and their functional impacts, still remains rare. Methods: In this study DNA were extracted from formalin fixed paraffin embedded samples followed by the conventional polymerase chain reaction and DNA sequencing. Computational analysis was performed using different algorithms to screen for deleterious SNPs. Results: The results demonstrate that there are synonymous SNPs (sSNPs) and non-synonymous SNPs (nsSNPs) in the TP53 gene that may be deleterious to p53 structure and function. Additionally, TP53 gene mutations were found in 40% of samples. Six out of ten of TP53 gene mutations occurred in exon 5, two mutation in exon 6 and other two were present in exon 8. Only one SNP in position E298Q was predicted to have a neutral effect and other SNPs were predicted to be disease related according to Mutation Taster software. A total of 37.2% of squamous cell carcinoma (SCC) samples were found to be mutated, 87.5% of them exist in exon 5, 12.5% in exon 6 and 6.3% in exon 8, whereas adenocarcinoma (AC) achieved a higher rate of mutation (57.1%) with 100% exon 5 involvement. Conclusions: Mutation of TP53 exon 5 in esophageal cancer patients were the most frequent. Genomic results have identified a higher TP53 mutation rate in esophageal AC in contrast to SCC.

Background: 16S rRNA gene sequence analysis is a robust tool for characterization of new pathogens in clinical specimens with suspected bacterial disease. The aim of this study was to characterize Pseudomonas aeruginosa isolated from clinical specimens by sequencing the 16S rRNA gene. Methods: Forty bacterial isolates were obtained from different clinical specimens (wound, urine and sputum) using enrichment selective media and biochemical tests to characterize and identify the bacteria as P. aeruginosa. DNA was extracted from P. aeruginosa using the Chelex method. A universal primer was used to amplify 16S rRNA genes by a conventional PCR technique. The amplified PCR products were sequenced, and the sequences were viewed by Finch TV program version 1.4.0. The identity and similarity of the nucleotide sequence of the isolated strains was detected by comparing them with published sequences using BLASTn. Phylogenetic trees were constructed using Phylogeny.fr software. Results: Sequence analysis by BLASTn displayed high similarity and identity with P. aeruginosa from China KX461910, Australia JN609194 and with other P. aeruginosa isolates from the GenBank database. Conclusions: Our observation of isolates from different origin sites, further show the utility of 16s rRNA PCR amplification. This reveals the high specify of the primers and accuracy of the PCR. Thus, 16S rRNA sequencing can be used to identify genetically atypical P. aeruginosa isolates from different origins.

Background: Infections by intestinal pathogens especially protozoans and helminths are considered to pose a real health problem, particularly in the tropics. They cause considerable morbidity and mortality rates in developing countries. The high prevalence of these infections is closely correlated with poverty, poor environmental hygiene, and impoverished health services. This study aimed to detect prevalence and frequency of parasitic infections among food handlers in Khartoum Sudan . Methods: Three hundred and fifty Food-handlers, attending public health laboratories in Khartoum, Sudan, for an annual medical check-up, were screened for intestinal parasites by four laboratory techniques viz. direct faecal examination, formal-ether concentration, Baermann technique and agar culture method. Results: The infection rate was 23.7% by Formol-Ether Concentration technique, followed by direct saline stool preparation (7.1%). Out of 83 positive samples the infection rate among different nationalities was as follows: Sudanese 68 (81.9%), Ethiopians 13 (15.7%), Syrians 2 (2.4%) and Egyptians 0 (0%). Intestinal parasites were more prevalent among males (73; 25.1%) than female food handlers (10; 16.9%). Three protozoans, nematodes, two tap worms and one trematode worm were detected among infected population: their frequency were as follows: Entamoeba histolytica (7.4%), Entamoeba coli (6.86%), Giardia lamblia (6%), Schistosoma mansoni (1.40%), Necator americanus (1.43%), Hymenolepis nana (0.68%), Strongyloides stercoralis (0.68%), Taenia saginata (0.57%), Ascaris lumbricoides (0.57%) and Trichostrongylus species (0.29%). Conclusion: The overall prevalence of protozoan infections among food handler in Khartoum state, Sudan was 20.26% while the helminthic infections was 5.97%. Formol-ether concentration technique is better for detection of intestinal parasites than the direct faecal smear technique. Likewise, Barmann’s technique confirms detection of nematodes worms especially hookworms.

Objectives: Knowledge of oral cancer affects early detection and diagnosis of this disease. This study aimed to assess the current level of public knowledge of oral cancer in Khartoum State, Sudan, and examine how demographic background factors affect this knowledge. Methods: This cross-sectional study involved 501 participants recruited by systematic random sampling from the outpatient records of three major hospitals in Khartoum State between November 2012 and February 2013. A pretested structured questionnaire was designed to measure knowledge levels. A logistic regression model was utilised with demographic background variables as independent variables and knowledge of oral cancer as the dependent variable. A path analysis was conducted to build a structural model. Results: Of the 501 participants, 42.5% had no knowledge of oral cancer, while 5.4%, 39.9% and 12.2% had low, moderate and high knowledge levels, respectively. Logistic regression modelling showed that age, place of residence and education levels were significantly associated with knowledge levels (P = 0.009, 0.017 and

Objectives: This study aimed to determine the pattern of hospital admissions and patient outcomes in medical wards at Atbara Teaching Hospital in River Nile State, Sudan. Methods: This retrospective cross-sectional study was conducted from August 2013 to July 2014 and included all patients admitted to medical wards at the Atbara Teaching Hospital during the study period. Morbidity and mortality data was obtained from medical records. Diseases were categorised using the World Health Organization’s International Classification of Diseases (ICD) coding system. Results: A total of 2,614 patient records were analysed. The age group with the highest admissions was the 56‒65-year-old age group (19.4%) and the majority of patients were admitted for one week or less (86.4%). Non-communicable diseases constituted 71.8% of all cases. According to ICD classifications, patients were admitted most frequently due to infectious or parasitic diseases (19.7%), followed by diseases of the circulatory (16.4%), digestive (16.4%) and genito-urinary (13.8%) systems. The most common diseases were cardiovascular disease (16.4%), malaria (11.3%), gastritis/peptic ulcer disease (9.8%), urinary tract infections (7.2%) and diabetes mellitus (6.9%). The mortality rate was 4.7%. Conclusion: The burden of non-communicable diseases was found to exceed that of communicable diseases among patients admitted to medical wards at the Atbara Teaching Hospital.

Hemoglobin A1c (HbA1c) is affected by the red blood cell (RBC) lifespan. The association of HbA1c with RBC indices in pregnant women is not widely investigated. In this study, we investigated the association between HbA1c and Hb/RBCs count and RBCs indices; specifically, Hb/RBCs count and indices in non- diabetic pregnant women. Across-sectional study was carried- out at the antenatal care of Saad Abu Elela Hospital, Khartoum, Sudan. Obstetrics history was gathered using questionnaire and body mass index was calculated. Fasting blood sugar, at one hour, at two hours post prandial and HbA1c were investigated. Complete blood count parameters of RBCs count was performed, including, hematocrit, Hb, RBCs indices of MCV, MCH, and MCHC. One hundred twenty three women were enrolled. The mean age of the participants was 28±5.6 years and a mean body mass index was 27.65±6.8 k/m2. There was significant positive correlation between HbA1c and Hb (r=0.174, P=0.037), Hct (r=0.174, P=0.037), and MCHC (r=0.180, P=0.031). A negative correlation between HbA1c and the platelet index PDW (r= –0.198, P=0.017) was documented. The rest of the other factors showed no correlation with HbA1c. In linear regression analysis, HbA1c correlated positively with Hb (P=0.044) and Hct (P=0.047). The present study shows a significant positive correlation between HbA1c value with Hb, Hct, and MCHC. No significant correlation between HbA1c and other RBCs parameters was observed.

Objective: This study aimed to determine the prevalence and assess antimicrobial susceptibility of extended- spectrum β-lactamase-producing Escherichia coli isolated from clinical specimens of patients at hospitals in Khartoum State, Sudan.Methods: During April to August 2011, a total of 232 E. coli isolates were collected from various clinical specimens of patients. Isolates were identified, tested for antimicrobial susceptibility and screened for ESBL production as per standard methods. The double-disk diffusion method was used to confirm ESBL production using antimicrobial disks of ceftazidime (30 μg), cefotaxime (30 μg), with or without clavulanic acid (10 μg). A zone difference of >5 mm between disks was considered indicative of ESBL production.Results: Out of 232 E. coli isolates, 70 (30.2%) were found to be positive for ESBL by the applied phenotypic methods. ESBL-producing isolates yielded high resistance rates for trimethoprim-sulfamethoxazole (98.6%), tetracycline (88.6%), nalidixic acid (81.4%) and ciprofloxacin (81.4%). The highest antimicrobial activities of ESBL-producing isolates were observed for amikacin (95.7%), followed by tobramicin (74.3%) and nitrofurantoin (68.6%). Resistance to quinolones, aminoglycosides, trimethoprim-sulfamethoxazole, tetracycline, nitrofurantoin and chloramphenicol was higher in ESBL than non-ESBL isolates (p

Background: Early diagnosis and prompt treatment are the basic elements of malaria control. The mother′s perceptions about the cause of the fever, duration of sickness, accessibility and the anticipated cost of treatment, frequent use of traditional medicine, and judgement of the severity of the fever are the most important determinants for effective treatment of fever in children. Subjects and Methods : This cross-sectional study was conducted in Kassala city, in Eastern Sudan to investigate the caregivers′ care-seeking behaviour related to fever among children < 5 years. Data was collected by trained social workers using a structured questionnaire and was analysed by means of SPSS. Results: Three-hundred fifty housewives were interviewed. The majority (85.7%) had had at least basic education and 244 (69.7%) were full-time housewives. A total of 237 (67.7%) mothers were found to have adequate knowledge about malaria. Malaria was perceived by only 143 (40.9%) of the respondents as a cause of low grade fever and this percentage was almost doubled in the case of high fever. There were similar findings with respect to the selection of treatment sources and the use of antimalarial drugs. High fever urged 319 (91.1%) to seek advice from health workers and 281 (80.3%) to take drugs other than chloroquine. Conclusion: The intensity of fever (low/ high) governed the respondent′s perceived causes of fever, decision about available treatment options and the type of antimalarial drugs they used. Health education programmes should focus on the importance of seeking early advice, compliance with prescribed treatment and awareness and handling of danger signs before presenting at health facility.

Aim: This study aimed to determine the level of infant and under-five mortality rates and to examine the effect of socioeconomic, demographic and environmental factors on the health status of the children under five years. Methods: The data for this study were collected by means of a questionnaire addressed to women in Wad-Medani, Sudan. Three hundred women in the reproductive age (15-49) years were chosen randomly for this study. The data were analyzed statistically using the Statistical Package for Social Sciences (SPSS). Frequency distributions and a statistical test based on Chi-square for independence was conducted. Results: Infant mortality rate was 77 per 100 and child mortality rate was 67 per 100. The results revealed that immunization, child order, child birth weight, birth interval and contraceptive use had a significant influence on the mortality of children under the age of five. The mother′s level of education is highly significant on the mortality of children under five years old. Conclusions: The Ministry of Health should give greater attention to improving immunization services and concentrate on health education campaigns for mothers and for the community.

Abstract Background Artemisinin-based combination therapy (ACT) is the treatment of choice for uncomplicated Plasmodium falciparum malaria in most areas of the world, where malaria is endemic, including Sudan. However, few published data are available on the use of ACT for treatment of P. vivax malaria. Methods This study was conducted at a health centre in Kassala, eastern Sudan, from October to December 2011. Patients with uncomplicated P. vivax malaria received artemether-lumefantrine (AL) tablets (containing 20mg artemether and 120 mg lumefantrine) and were monitored for 28 days. Results Out of the 43 cases enrolled in this study, 38 completed the 28-day follow-up. Their mean age was 25.1 years (SD: 1.5). On day 3 following AL treatment, all of the patients were afebrile and aparasitaemic. By day 28, all 38 patients exhibited adequate clinical and parasitological responses to AL treatment. The cure rate was 100% and 88.4% for the per protocol analysis andfor the intention to treat analysis, respectively. Mild adverse effects (nausea, vomiting, abdominal pain, dizziness and/or rash) that resolved spontaneously were observed in four (10.5%) of the patients. Conclusion AL combination therapy was fully effective for treatment of P. vivax malaria in the study in eastern Sudan. Trial registration Trial. Gov: NCT01625871

426 4-17-year-old children (89% males) from the Jonglei Province and 50 12-and 15- year-old children from Juba town in Southern Sudan were examined according to WHO criteria (9). The prevalence calculus and intense gingivitis was high, and highest at ages 8 and 9 years. 8% of 15-year-old children had advanced periodontal disease but this was confined to the anterior mandibular region. Caries prevalence was very low, but much higher in Juba town (36% at both age 12 and age 15 years) than in the Jonglei Province children (4% at 12 years and 8% at 15 years of age). The pastoral, isolated existence of the inhabitants of the Jonglei Province is likely to change with the completion of the Jonglei canal. [ABSTRACT FROM AUTHOR]

The article presents information on a study which analyzes the attitudes of Sudanese mothers about the continuation of female circumcision in their families. Also, it examines behavioral and attitudinal data in order to investigate the perpetuation of the practice of female circumcision, also known as female genital mutilation, in the Sudan. Furthermore, this study describes the various types of circumcision experienced by girls, briefly discussing the terminology involved, and explores the reasons that generally are cited for the perpetuation of the custom. It was found that close to 90% of all women surveyed either had circumcised or planned to circumcise all of their daughters. Also, roughly half of those women reported favoring the most severe procedures. Finally, this analysis shows that, Muslim women were more apt than Christian women to plan to have their daughters circumcised and to favor the continuation of the practice, but they were less likely to state a preference for the Pharaonic form over milder procedures.

Background: The protein product of the normal TP53 gene performs an essential function in cell cycle control and tumor suppression, and the mutation of a TP53 gene is an essential step in the development of many cancers. Despite the reported association of TP53 gene mutations with many human cancers, the comprehensive computational analysis of single nucleotide polymorphisms (SNPs), and their functional impacts, still remains rare. Methods: In this study DNA were extracted from formalin fixed paraffin embedded samples followed by the conventional polymerase chain reaction and DNA sequencing. Computational analysis was performed using different algorithms to screen for deleterious SNPs. Results: The results demonstrate that there are synonymous SNPs (sSNPs) and non-synonymous SNPs (nsSNPs) in the TP53 gene that may be deleterious to p53 structure and function. Additionally, TP53 gene mutations were found in 40% of samples. Six out of ten of TP53 gene mutations occurred in exon 5, two mutation in exon 6 and other two were present in exon 8. Only one SNP in position E298Q was predicted to have a neutral effect and other SNPs were predicted to be disease related according to Mutation Taster software. A total of 37.2% of squamous cell carcinoma (SCC) samples were found to be mutated, 87.5% of them exist in exon 5, 12.5% in exon 6 and 6.3% in exon 8, whereas adenocarcinoma (AC) achieved a higher rate of mutation (57.1%) with 100% exon 5 involvement. Conclusions: Mutation of TP53 exon 5 in esophageal cancer patients were the most frequent. Genomic results have identified a higher TP53 mutation rate in esophageal AC in contrast to SCC., Competing Interests: No competing interests were disclosed.