Kordofan Journal of Medical & Health Sciences
The Kordofan Journal of Medical & Health Sciences (KJMHS) is a biannual, peer-reviewed, open-access scientific journal published by the Faculty of Medicine and Health Sciences, University of Kordofan, El-Obeid, Sudan. Established to advance the dissemination of medical knowledge and promote evidence-based healthcare practice, the journal provides a platform for researchers, clinicians, educators, and public health professionals to publish high-quality original research, review articles, case reports, and short communications in all fields of medical and health sciences.
New-Onset Type 1 Diabetes Mellitus Triggered by COVID-19 with Severe DKA and Asymmetric Neuropathy: A Case Report
Pediatric critical care / PICU, Acute kidney injury (AKI)
Copyright (c) 2026 Alddai Alnair, Anasalwogud Ahmed, Maged Nabawi, Bashir Elnaem, Aman Sohal, Amal Sherif (Author)
When a Tooth Becomes a Foreign Body: A Rare Pediatric Airway Emergency A Case Report
Foreign body aspiration is considered as a top emergency in children, which demands immediate detection and prompt medical response. The extraction of teeth as aspirated foreign bodies is extremely rare because their sharp edges make it difficult to extract from the distal airways. A two-year-old female patient had her upper incisor tooth aspirated after a fall which resulted in multiple unsuccessful bronchoscopic retrieval attempts leading to repeated hypoxic arrests. The case shows the diagnostic and therapeutic challenges of distally impacted airway foreign bodies and performs safe and timely surgical procedures when standard bronchoscopic techniques are ineffective.
Copyright (c) 2026 Alnameir Ibrahim, Abdelrahman Eltigani, Salma Alhusain, Anfal Elhaja, Salma Aldwahi, Alddai Alnair (Author)
Clinical features and Outcome of Neonatal Conditions at El-Obeid Paediatric Specialized Hospital, Sudan
Background: Neonatal mortality accounts for 46% of under-five deaths worldwide. In Sudan, the neonatal mortality rate is 29.4 per 1000 live births. Aim: To determine the clinical characteristics and outcome of neonates admitted to El-Obeid Specialized Pediatrics Hospital in Western Sudan. Methods: Retrospective, descriptive hospital-based study. Data were collected from the medical records of newborns admitted to the hospital between January 2015 and July 2018. Relevant socio-demographic and clinical information was collected on a prepared standard form. Descriptive and analytical statistics were used to summarize the study variables. Results: A total of 1,662 neonates were enrolled during the specified period. About 56% of the cases were male. Neonatal sepsis was the most common clinical condition, occurring in 83.4% of cases. Most cases (88.3%) presented with fever and 28.7% had jaundice. The overall mortality was 2.3%, of which about a quarter occurred within the first week after birth. Conclusion: Neonatal morbidity and mortality still account for a large proportion of the burden of disease in children under 5 years of age. Identifying the risk factors associated with neonatal death is very important to guide the development of effective interventions to reduce neonatal mortality.
Copyright (c) 2026 Alam-Eldin M. Mustafa, Niemat Mohammed Tahir, Mohammed Abdullah Alshehri, Safiedin I. Elsafi, Abubakr A. Omer, Mohamed A. Desogi, Fahad A. Elnour, Nahid A. Ali, Haitham M. Awadalla (Author)
Assessment of Drinking water Quality in El-Obeid City North Kordofan State, Sudan
Background and Objective: Access to safe drinking-water is essential to health as water can become unsafe at any point between collection and consumption, this study aimed to assess the physicochemical and bacteriological quality of drinking water in El-Obeid City, North Kordofan State, Sudan (2022 – 2025). Materials and Methods: A descriptive cross-sectional study was conducted. Sample size determined according to World Health Organization (WHO) guidelines for water sampling measurement. The samples were distributed across three sources: households (20), animal carts (12), and pump/wells (8). water samples were collected and analyzed for parameters including (PH – Nitrite- Fluoride - Hardness – Calcium - Magnesium – Residual free chlorine and Total Dissolved Solids) and the presence of coliform bacteria Escherichia coli (E. coli). Results: The findings showed that 72.5% of water samples were contaminated with Escherichia coli, with the highest contamination from animal carts (83%), followed by households (70%), and pump/wells (62.5%). Conclusion: The findings emphasize the need for improved water treatment and targeted interventions to ensure safe drinking water and mitigate waterborne disease risks.
Copyright (c) 2026 Loaey Emad Eldeen Abdalla Mohmed, Somia Ali Mohammed Ibrahim (Author)
Do We Need to Follow International Guidelines for Empirical Antibiotics Selection in Critically Sick Children? A Case series
Background: Sepsis is a leading cause of pediatric critical illness and mortality. Choosing empiric antibiotics based solely on international guidance may be inadequate where local resistance patterns differ. Methods (Case Series Description): We describe two infant cases with rapidly progressive septic shock, purpuric/necrotic skin lesions, and multi-organ failure. Results: Blood/CSF/lesion cultures in both cases grew Pseudomonas aeruginosa resistant to initial ceftriaxone+vancomycin; one isolate was imipenem-susceptible after escalation. Despite maximal organ support, both infants died. Conclusion: While international guidelines standardize care, empiric therapy in critically ill children should be tailored to local epidemiology and AMR surveillance, ensuring early coverage for Pseudomonas where prevalence warrants.
Copyright (c) 2026 Anasalwogud Ahmed, Aaqib Ahmed, Maged Nabawi, Ayman Gouda, Mohamed Babiker (Author)
Comparison of Culture, GeneXpert and Two Staining Techniques with Fine Needle Aspiration in Diagnosis of Tuberculous Lymphadenitis, Khartoum, Sudan: A Prospective Cross-Sectional Study
<p class="MsoNormal" style="margin-bottom: 0in; text-align: justify; line-height: normal; mso-pagination: widow-orphan lines-together; page-break-after: avoid; mso-outline-level: 1; border: none; mso-border-left-alt: solid #C0504D 1.5pt; mso-border-left-themecolor: accent2; mso-border-bottom-alt: solid #C0504D 1.5pt; mso-border-bottom-themecolor: accent2; padding: 0in; mso-padding-alt: 0in 0in 1.0pt 4.0pt;">Introduction: Investigations of tuberculous lymphadenitis are challenging for clinicians. Using multimodality patterns may yield a better outcome. The objective is to compare the various laboratory methods; GeneXpert, culture, ZN stain and Auramine-Rhodamine stain in diagnosing tuberculous lymphadenitis. Method: This study is a prospective cross-sectional laboratory-based study. The study was conducted in Khartoum, Sudan. Specimens obtained from lymph nodes were examined cytologically, culture, GeneXpert, Auramine-Rhodamine stain and ZN stain laboratory methods were applied for all specimens, and all cases were initially diagnosed as tuberculous lymphadenitis by FNAC. Patients' sociodemographic data anthropometric measurements, clinical examination and diagnostic tools were also gathered. SPSS version 23 was used for data analysis. Results: a total number of 105 cases were included, 53.3% were males. The mean age was 27.29 ± 15.94. The most affected age group was 19 – 30 (33.3%). The most affected lymph node group was the cervical group 83 (79.0%); furthermore, 81(77.1%) patients had a single lymph node affected while 24(22.9%) cases had multiple lymph nodes. The main cytomorphological pattern identified was necrotizing granulomatous lymphadenitis 79(75.2%). GeneXpert Positive cases were (41.0%), ZN staining (4.8%), Auramine- rhodamine stain (5.7%) and culture showed growth among (45.7%) of the cases. Sensitivity against FNAC was as follow: culture 64.81%, GeneXpert 62.87%, ZN stain 51.22% and Auramine-Rhodamine stain 51.47%. On the other hand, sensitivity and specificity against culture was calculated as follow: FNAC 100%, GeneXpert 80.0%, ZN stain 51.61% and Auramine-Rhodamine stain 53.33%. Specificity, as based on culture, was as follows FNAC 54.28%, GeneXpert 89.06%, ZN stain 96.61% and Auramine-Rhodamine stain 100%. Conclusion: combining various diagnostic methods for caseating necrotizing cytomorphology cases yields less than 50% positivity. FNAC is recommended as the first-line test for suspected tuberculous lymphadenitis due to its higher sensitivity, rapidity, practicality, and cost-effectiveness. In inconclusive cases or those with a suppurative background, especially suspected TBLN, culture and GeneXpert are advised.
Copyright (c) 2026 Marwa H. Yagoub, Ahmed O Almobarak, Wadie Elmadhoun, Rasheeda Hamid Abdalla, Mohamed H Ahmed, Nuha Yousif Ibrahim (Author)
Clinical, Biochemical, and Ultrasonographic Characteristics of Women with Suspected Polycystic Ovary Syndrome in El-Obeid
Background: Polycystic ovary syndrome (PCOS) is the leading endocrine disorder among reproductive-aged women. Despite its prevalence, Sudanese data remain limited. Objectives: To describe the clinical presentation, hormonal abnormalities, and ultrasonographic findings among Sudanese women with suspected PCOS. Methods: Descriptive cross-sectional study of 120 symptomatic women aged 15–45 years. Consecutive sampling was used. Clinical evaluation, hormonal assays, and pelvic ultrasound were performed using Rotterdam criteria. Results: Menstrual irregularity (58.3%), hirsutism (47.5%), acne (41.7%), and acanthosis nigricans (38.3%) were common. Ultrasound confirmed polycystic ovarian morphology (PCOM) in 68.3%. Elevated LH/FSH ratio and testosterone were observed in 47.5% and 45% respectively. Significant correlations were found between BMI and hirsutism (r=0.52), LH/FSH ratio and testosterone (r=0.44), and ovarian volume and LH (r=0.48). Conclusion: The clustering of reproductive, hormonal, and ultrasound abnormalities highlights the classical PCOS phenotype. Early integrated diagnostic assessment is essential. Findings are not generalizable due to the hospital-based design [1,2].
Copyright (c) 2025 Kordofan Journal of Medical & Health Sciences
Musculoskeletal pain patterns in a group of Sudanese surgeons
Background: Surgeons frequently experience work-related musculoskeletal pain, which is a prevalent problem. This study aims to evaluate the patterns of musculoskeletal pain among a group of Sudanese surgeons. Methodology: This study utilized a cross-sectional survey design, in which 84 volunteers residing in the city of El-Obeid, located in the Northern Kordofan state, participated. We randomly selected contributors between May 2024 and June 2024, without taking into account their age or gender. Results: About 65.5% of the subjects, consisting of 75% females and 63% males, reported experiencing lower back pain. 43% of individuals reported experiencing neck pain, with 37.5% being women and 44% being men. The study found that males have a higher risk of experiencing neck pain. We calculated the relative risk (RR) to be 1.250, with a 95% confidence range (95%CI) of 0.501-3.122. A quarter of the participants, specifically 37.5% of females and 22% of males, reported experiencing shoulder pain. The likelihood of experiencing shoulder pain is slightly higher in females compared to males, with a relative risk (RR) of 1.178 (95% confidence interval [CI]: 0.880–1.576). Conclusion: Musculoskeletal discomfort is common among surgeons of various specialties in Sudan. The most often reported musculoskeletal pain was lower back, neck, and shoulder discomfort.
Rabaah ALadawya Mohammed Salih Elbasheri Gadkreem
Copyright (c) 2024 Kordofan Journal of Medical & Health Sciences
Fetal outcomes in traditional gold mining areas, Sudan
Background: Pregnancy during heavy metal toxicology is associated with various unfavorable consequences for both the mother and the fetus. Therefore, the aim of this study was to assess the fetal outcomes for pregnant women living in traditional gold mining areas in North Kordofan, Sudan. Methodology: The Obstetrics and Gynecology Teaching Hospital in North Kordofan State, El-Obeid City, Sudan, conducted this descriptive transaction case-control study from January 2018 to December 2023. The distribution of the 270 study participants was as follows: About 135 patients from traditional gold mining areas attended El-Obeid Obs. @ Gyn. Teaching Hospital for maternity services, and another 135 from non-gold mining areas as a control. Results: The average baby weight was 2.5–3.5 kg for 98 (83.7%) of the cases and 77 (74.7%) of the controls. Most study participants had healthy babies. The study involved 85 (44%) cases and 79 (65%) controls, with NICU admission following each case. 16(12%) of the cases and 18(14%) of the controls give birth to stillborn babies; 12(9%) and 6(5%) of the controls give birth to nonviable babies; 14(11%) and 18(14%) of the controls give birth to nonviable babies; and 4(3%) and 3(2%) of the controls give birth to congenital malformed babies. Conclusion: Exposure to these elements has altered the fetal development of pregnant women in traditionally gold-mining areas in Sudan.
Maternal and fetal outcomes of home births in Western Sudan
Background: In light of the ongoing Sudanese crisis, many pregnant women are having trouble getting the medical care they seek. Thus, the current study sought to evaluate the effects of home births in Western Sudan on both mothers and their newborns. Methodology: From January to December 2023, in the Obstetrics and Gynecology teaching hospital in El-Obeid, North Kordofan State, Sudan, we conducted a descriptive longitudinal investigation for this study. This study has recruited approximately 224 participants. Results: The most common maternal outcomes observed in this group of patients were postpartum hemorrhage, followed by puerperal sepsis and eclampsia, accounting for 14.3 percent, 13%, and 9 percent of cases, respectively. Fresh stillbirth accounted for the majority of cases, while macerated stillbirth, fetal distress, and birth trauma accounted for 28%, 17%, 15%, and 9% of the cases, respectively. Conclusion: Home birth is widespread in Sudan; however, it might harm the mother and baby. Postpartum hemorrhage, puerperal infection, and eclampsia are the main maternal consequences. Fresh stillbirth, macerated stillbirth, fetal distress, and delivery trauma are common fetal outcomes. Prioritize maternity and prenatal care system improvements
Pattern of Conjunctival Diseases in North Kordofan State
Background: The conjunctiva is one of the most important elements of the eye because it covers the anterior white sclera and reflects on the eyelids, providing protection and lubrication while also producing mucus, which is an important component of the tear film. It also serves as a protective barrier against germ entry into the eye and aids in immunity. It is highly vascularized and has numerous lymphatic vessels. Some conjunctival disorders are caused by trauma, such as subconjunctival hemorrhage and conjunctival tear, while others are caused by infection, such as trachoma and conjunctivitis. Methodology: The study was carried out at the Ophthalmology Emergency Department of surgery El-Obeid Teaching Hospital and Dr. Khalil's Ophthalmology Center in North Kordofan State, Sudan. It was retrospective, descriptive research. The study sample covered all conjunctival illnesses, data was drawn from the medical record of 1000 patients with varied eye conditions, 175 patients with conjunctival diseases were selected. Results: This study investigated 175 patients with conjunctival abnormalities to determine the frequency of these diseases in North Kordofan state. The findings showed that conjunctival illnesses were more common in men, with 95 out of 175 cases (54%) and 80 out of 175 (46%) being females. The male-to-female ratio was 1.2:1, and the age range of 21-33 years was the most frequent, accounting for 33%. This was followed by the age groups of 33-53 years, 10-20 years, <9 years, and beyond 54 years, with percentages of 20%, 19%, 18%, and 10%, respectively. Subconjunctival hemorrhage was the most common type of conjunctival illness, accounting for 54% of cases, followed by conjunctivitis 17%, pterygium 15%, conjunctival tear 9%, pinguecula 3%, conjunctival nevus 1%, and trachoma. Conclusion: Conjunctival disorders were prevalent in Northern Kordofan state, with the most common being subconjunctival hemorrhage, conjunctivitis, pterygium, and conjunctival tear.
Posterior Reversible Encephalopathy Syndrome in a Young Sudanese Female - Case Report
Introduction: Posterior reversible encephalopathy syndrome (PRES) is a rare, reversible radio-neurological condition. It commonly presents with seizures, visual disturbances, headaches, impaired level of consciousness, and other focal neurological findings. PRES is often associated with high blood pressure and can result from various causes, including autoimmune disorders, certain medications, and eclampsia. Pathophysiologically, it is characterized by reversible vasogenic cerebral edema predominantly in the occipital and parietal lobes. We report a case of a young Sudanese female with systemic lupus erythematosus (SLE), presenting with generalized seizures and headache. These symptoms occurred without fever and were associated with high blood pressure. Neuro- radiological imaging findings, typical clinical presentation, and the reversibility of the condition confirmed the diagnosis of PRES. This is, to the best of our knowledge, the first case report of PRES in SLE patients from El Obeid, North Kordofan, Western Sudan
The value of ICT and Latex Serological tests in Screening for Toxoplasma gondii
Background: Toxoplasma gondii is an intracellular zoonotic parasite responsible for infections in various warm-blooded animals and humans. This study primarily focused on evaluating the diagnostic efficacy of ICT and latex serological methods for screening Toxoplasma gondii in North Kordofan, Sudan. Methodology: This descriptive study was conducted in El-Obeid, North Kordofan State, Sudan, from January to May 2024. A total of 260 samples were collected from women who had experienced abortions or had a previous history of such events. A blood sample was collected from each respondent to conduct serological tests, including ICT, latex, and ELISA. Results: The study involved approximately 260 women to evaluate the validity of the various techniques employed. In this research, ICT and LaTeX were compared with ELIZA as the gold standard method, yielding a positive rate of 14.6% and a negative rate of 85.4% using ICT methods. However, the results from the Latex method indicated a positivity rate of 15.8%, while the negativity rate stood at 84.2%. In ELIZA, 17.3% is positive, while 82.7% is negative. The sensitivity and specificity of the techniques employed in this study are compared with the ELISA technique, as detailed in the following tests. The sensitivity achieved through the ICT technique was 84%, while the specificity reached 100% as observed in the findings. The sensitivity and specificity obtained through the latex technique were determined to be 94% and 100%, respectively. Conclusion: Both Latex and ICT demonstrate relatively better sensitivity and very good specificity, making them suitable for screening and diagnostic purposes in conflict areas.
Frequency of Hepatitis B infection among Hemodialysis Patients at Aljomih Center, ElObied, Sudan, 2024
Background and objectives: Hepatitis is inflammation of the liver due to viral infection and leads to significant morbidity and mortality. The HBV is highly infectious and the virus can be spread through vertical transmission or horizontal transmission by exposure to blood, body fluid of infected individuals. HBV infection is considered as major public health problems worldwide. This study aimed to find out Frequency of Hepatitis B infection among Hemodialysis Patients at Aljomih Center, Elobied, Sudan, 2024. Method and patients: this Descriptive cross-sectional facility- based study included all patients of hemdialysis at Aljomih center during the study period (126 patients). Results: the study showed that 8 (6.3%) of hemodialysis patients have Hepatitis B infection. Most individuals were males 97 (77.0%), and 8 (6.3%) of them were HBV positive, 29 (27%) of patient were females. The patients were classified into four age groups. Moreover, 124 (98.4%) of the patients had previous blood transfusion and 8 (6.3%) were HBsAg positive. this study elucidated that 92 (73%) of participated were hypertensive and 2 (1.58%) of them were HBsAg positive. On the other hand, 10 (7.9%) of hemodialysis patients included in this study were diabetics and all of them were HBsAg negative. Conclusion: The prevalence of hepatitis B infection among HD patient was generally high (6.3%). More effort should be done to reduce this frequency of HBV among hemodialysis patients.
Common comorbidities among tuberculosis patients in Western Sudan during the Sudan armed conflict.
Background: Tuberculosis continues to be the primary cause of death from infectious diseases globally. In low- and middle-income countries, TB significantly contributes to morbidity and mortality, particularly among patients with comorbidities such as HIV infection, diabetes mellitus, smoking, depression, chronic obstructive pulmonary disease, and pulmonary TB. HIV co-infection elevates the risk of progression to developed tuberculosis (TB) disease. This study evaluated comorbidity in tuberculosis among patients attending El-Obeid Teaching Hospital during the armed conflict from 2023 to 2024. Methodology: This descriptive retrospective study took place in the respiratory department of El-Obeid Teaching Hospital in North Kordofan State, Sudan. The study examined 751 patients diagnosed with tuberculosis, alongside detailed coverage files from the early years of the Sudan war. We collected the data in August 2024. We developed a thorough data collection sheet and methodically organized all pertinent data. Results: Of the 751 patients, 692 received a tuberculosis (TB) diagnosis without any comorbidities, making up 92% of the cohort. The remaining 59 patients, accounting for 8%, had TB with comorbidities: 40% with diabetes mellitus (DM), 29% with HIV, 15% with hypertension (HIN), and 7%, 6%, and 3% with chronic kidney disease (CKD), bronchial asthma, and cardiac disease, respectively. The majority of patients were over 60 years old, comprising 37% of the cohort. The majority of the patients were unemployed, and their tuberculosis treatment outcomes were complete. Conclusion: Tuberculosis (TB) with comorbidity is more prevalent in diabetic patients than in those with HIV. We recommend regular screening for chronic comorbid diseases to improve treatment outcomes and minimize complications. Additionally, promoting outpatient care is essential for improving TB management, and further surveillance is necessary to fully understand the extent of the issue.
Twin pregnancy generally represents a high-risk pregnancy, but monozygous twin pregnancy is a particular challenge for the obstetrician due to the serious complications that may occur during its evolution. A very rare, severe complication of monozygous twin pregnancy, which we recently dealt with in the Obstetrics and Gynecology Department of the Omdurman maternity Hospital Sudan, was a monochorionic monoamniotic twin pregnancy with acardiac twin (TRAP). One of the fetuses (acardiac twin) presented as amorphous mass without any recognizable structure, being transfused by the other fetus with a normal heart (pumping twin). The understanding of these cases is mandatory in order to offer maximum survival and heath chances to the viable fetus.
Extrapulmonary tuberculosis in Western Sudan during the armed conflict 2023-2024
Background: Tuberculosis represents one of the foremost infectious cause of mortality globally; the disease is endemic in Sudan and has experienced a significant increase amid the ongoing armed conflict. This study aims to investigate extrapulmonary tuberculosis in Western Sudan during the conflict period from 2023 to 2024. Methodology: A descriptive retrospective study was conducted at El-Obeid Teaching Hospital in North Kordofan State, Sudan, from August 2023 to September 2024. This was conducted on 233 patients diagnosed with extrapulmonary tuberculosis from a total of 751 patients with tuberculous infections. The study collected all data related to the patients from the hospital records during the specified period from 15 April 2023 to 15 April 2024. A total coverage of all patients diagnosed with extrapulmonary tuberculosis within the designated time frame, irrespective of any inclusion or exclusion criteria. Results: The data revealed that 65% were males and 35% were females. The most prevalent age group is > 46, followed by < 18, 26-35, and 36-45, with incidence rates of 37%, 18%, 17%, and 13%, respectively. The majority of the patients (59%) lived in urban areas, while 41% in rural areas.63% of them were married, while 35% were single. Tuberculous lymphadenitis was the most prevalent type of extrapulmonary tuberculosis, followed by tuberculous pleuritis, abdominal TB, spinal TB, tuberculous pericarditis, and TB meningitis (39%, 28%, 14%, 12%, 5%, and 2%, respectively). Conclusion: Extrapulmonary tuberculosis is widespread in western Sudan, with tuberculous lymphadenitis and tuberculous pleuritis being the most common manifestations of the disease. This study indicates greater values than what was previously recorded in the world. In Western Sudan the disease primarily affects middle-aged males, with the majority of cases presented beyond the 2 months period. The near-collapsed economy, the inadequately equipped health system, and the detrimental effects of the armed conflict were the primary factors in the study's findings.
Assessment of Neutrophil Lymphocyte Ratio and Platelet Lymphocyte Ratio as Inflammatory Markers among Sudanese Patients with Chronic Kidney Disease in Kordofan state- 2024
Background and Objective: Low grade chronic inflammation is one of the central pathophysiological factors in chronic kidney disease (CKD). The complete blood count is a routine, inexpensive and easy test that provides information about formed blood contents. Neutrophil/lymphocyte ratio )NLR) and platelet lymphocyte ratio (PLR) are simple parameters and novel inflammatory marker, which may be used in many diseases for predicting inflammation. The aim of this study is to assess the utilization of NLR And PLR as inflammatory markers in patient with CKD. Methods: A cross- sectional descriptive study including 59 participants at different stage of CKD which was conducted. CKD was assessed based on glomerular filtration rate (GFR). Quantitative C-reactive protein (CRP) was analyzed by a fluorescence immunochromatographic methods as the bench inflammatory marker. NLR and PLR were calculated after complete blood count was performed. Results: Based on CRP value the participants were subdivided into two groups the first is group without inflammation (CRP <1) and the second with inflammation (CRP > 1). The study revealed the mean of NLR was slightly higher (3.08) in the group that had inflammation, unlike other (2.78). while the mean PLR within normal range in two groups (inflamed = 132.5, non-inflamed = 151.7). our study was showing positive correlation between NLR and CRP (R= 0.05, P= 0.000). with regards to PLR and CRP the correlation was not significant. Conclusion: Depending of these results, it can be concluded that NLR, together with CRP, may serve as a marker of systemic low-grade inflammation in patients with CKD. Larger prospective cohort studies in various ethnic groups are required to assess the possibility of using NLR as an alternative marker for CRP in patients with CKD.
Relationship Between Obesity and Hypertension among Sudanese Hypertensive Patients Attending Health Centers in El-Obeid City, North Kordofan State, West of Sudan
Background: Hypertension has been recognized as the most common cardiovascular disorder and a major risk factor for cardiovascular diseases (CVDs), chronic kidney disease, cognitive impairment and loss of vision. It is known as ‘the "silent killer" because it can be asymptomatic for many years. Obesity and/or abdominal obesity, are the main hypertensinogenic factor. Objectives: The aim of this study is to determine the relationship between obesity indices and hypertension among Sudanese hypertensive patients. Methodology: A cross-sectional hospital-based study was conducted in three health centers in El-Obeid city, West Sudan. Data were collected on anthropometric measurements (height, weight, Body Mass Index (BMI), waist circumference WC) and blood pressure (BP) measurement. The data were analyzed by the Statistical Package of Social Science (SPSS) software version 23.0. Independent sample t test, Chi-square (χ2) test and Pearson’s correlation coefficient were used. p value of ≤ 0.05 was taken as measure of statistical significance. Results: A total of 100 subjects, 19 males and 81 females, were voluntary enrolled in this study. The mean age was 53.05 (±8.28), the mean value of BMI was 28.21 (± 5.577), WC was 92.79 ± 11.009, SBP was 138.20 (±14.591), DBP was 85.50 (±9.252). Thirty-seven, (37%) were overweight, (33%) were obese, (25%) milled (class Ι), (6%) moderate (class ΙΙ) and (2%) severe obesity (class ΙΙΙ). Seventy-six, (76%) have central obesity (WC >102 cm for men and >88 cm for women). There was a statistically significant positive correlation between BMI and WC (p < .001), BMI and SBP (p = .045), WC and SBP (p = .026), WC and DBP (P = .001). Conclusion: Hypertensive patients had a high prevalence of overweight, obesity, abnormal/high BMI, and WC (central obesity). BMI and WC were positively correlated with BP. Lifestyle modification toward weight reduction is recommended in these patients. Additionally, obese persons must pay attention to their weight and try to lose weight to prevent hypertension.
Case Report, Red Blood Cell Autoagglutination: A laboratory challenge
Introduction: Red cell agglutination or autoagglutination is a phenomenon in which red blood cells clump together, forming aggregates. It is caused by the surface of the red cells being coated with antibodies. This often occurs in cold agglutinin disease, a type of autoimmune hemolytic anemia in which people produce autoantibodies (termed cold agglutinins) [1]. Sometime may develop cold agglutinins from lymphoproliferative disorders, from infection with Mycoplasma pneumoniae or Epstein–Barr virus, or idiopathically. Cold agglutinins (CA) are monoclonal or polyclonal antibodies activated at low temperatures and lead to autoagglutination of the RBC membrane [2]. Binding of CA causes agglutination of erythrocytes and the antigen-antibody complex induces complement-mediated hemolysis. Intravascular hemolysis occurs due to direct complement mediated lysis while extravascular hemolysis is as a result of C3b coated red cell destruction by macrophages in the liver [3]. Patients show hemolytic anemia of varying degrees of severity, as well as episodes of hemoglobinuria and acrocyanosis, which arise or worsen upon exposure to low temperatures. Blood cell aggregates are counted as single cells by the automated analyzers used to run complete blood count tests [4]. This leads to a markedly decreased red blood cell count and hematocrit and markedly elevated mean cell volume and mean cell hemoglobin concentration. Red cell agglutination also interferes with routine methods for blood typing and blood compatibility testing, which rely on agglutination reactions. [5,6]
Macroscopic Normal Appendix in Patients Presented with Features Suggestive of Acute Appendicitis
Background: Acute appendicitis is one of the most common causes of abdominal pain requiring surgical intervention. However, a subset of patients presents with classical symptoms suggestive of appendicitis, but intraoperative findings reveal a macroscopically normal appendix. This study aimed to evaluate the clinical, radiological, and histopathological characteristics of such cases. Methods: This prospective study included 100 patients who presented with clinical features suggestive of acute appendicitis and underwent appendectomy. Only those with macroscopically normal appendices were included. Clinical symptoms, physical signs, laboratory and radiological findings, intraoperative observations, and histopathological results were collected and analyzed. Results: Out of 100 patients 65 were females and 35 males. All of them reported right iliac fossa pain. Nausea was present in 80%, fever in 67%, and vomiting in 49%. Tenderness in the right side of the abdomen was noted in 97 patients (69 females, 28 males), while 3 patients (2 females, 1 male) presented with flank pain, anorexia, elevated white blood cell count, and negative β-hCG. Per rectal examination in these 3 patients revealed tenderness. Clinical examination showed RIF tenderness in 56% and rebound tenderness in 41%. Fever was documented in 53%. White blood cell count was elevated in 45% of patients. Ultrasound, performed in female patients only (40 cases), was non-diagnostic in all. Intraoperatively, all appendices were macroscopically normal. Thirteen females were found to have ruptured ovarian follicles. Histopathological examination revealed true appendicitis in 19 patients (13 males and 6 females), including 6 with normal white blood cell counts. Conclusion: A macroscopically normal appendix may still harbor histological evidence of inflammation. Clinical judgment should be supported by histopathology, especially in female patients, where gynecological conditions may mimic appendicitis. Improved diagnostic tools and imaging protocols are essential to reduce negative appendectomy rates.
Assessment of Quality Control Procedures at the Central Blood Bank of North Kordofan State
Background: Blood banks play an important role in the health care system's blood supply, and the goal of quality control methods is to ensure that patients receive safe and efficient blood transfusions while also preventing transfusion-transmitted infections. Improved quality services, leading to safer transfusion methods and fewer unfavorable consequences. Therefore, this study aimed to assess the quality control procedures at the Central Blood Bank of North Kordofan State. Methodology: This descriptive prospective study was conducted in the central blood bank in El-Obeid, North Kordofan State, from October 2021 to March 2022. The goal of this study is to analyze quality control measures in central blood banks and to provide potential options for improving the quality of blood transfusion services in the state. Results: A total of 400 units of blood components were selected by simple random method. Packed red cell units were evaluated for CBC, pH, unit volume, and blood culture. The results showed: The packed red cells had a mean HCT of 44.1 g/dl, with less than 80% HCT. The mean values for RBC, WBC, MCV, MCH, and MCHC were 5.0 × 10 12 /l, 5.058 × 10 9 /l, 75.2 FL, 27.0 pg, and 28.6 g/dl, respectively. Random donor platelets had a mean yield of 5942.0×109/L, with 73% yielding less than the necessary threshold. Only three (3%) units yielded ≥5.5 × 109/L. The pH was ≥6.2 in 100% of units, with a mean of 7.0 ± 0.0. All plasma units had a volume below the norm (100%). According to the study, the mean factor VIII levels for FFP were 79.3 IU/mL. (90%) of units contain factor VIII in accordance with intended levels, while only 8% have factor VIII below desired levels. The mean fibrinogen level was determined to be 364.8 IU/mL, with 24% having normal fibrinogen levels and 71% having levels higher than the usual range of ≥150 IU/mL. For plasma, the mean PT is 15.2s, which is 55% in agreement with the standard level and 45% higher than the standard level, and the activated prothrombin time mean is 68% in 100 units, which is in agreement with the standard level but only 21% higher. Conclusion: Our investigation revealed a decrease in the levels of QC out of range in the blood component. Such studies are proposed to improve quality measures in western Sudan.
Patterns of hematological malignancies in Kordofan Oncology Center, Sudan
Background: Hematological Malignancies (HM) incidence is uprising in developing countries with limited resources especially in Sudan. Methodology: This descriptive retrospective study was conducted by utilizing leukemia data acquired from Kordofan Oncology Center for Chemotherapy, El-Obeid, Sudan between 2016 to 2023. The study included a total of one hundred patients. Data were retrieved from the files of patients who were admitted to Kordofan Oncology center with hematological malignancies. Results: CLL is the most prevalent HM representing 61%, followed by CML accounting for 17%, then NHL which is 11%, MM 6% and HL 3%. Approximately 58% of males and 42% of females were affected with HM. Although HM were more prevalent among older individuals, chronic lymphocytic leukemia (CLL) was more usually observed in those aged over 71 years, accounting for 23 out of 61 cases (36%). The majority of participants in this study were persons residing in urban areas. The majority of patients with HM were housewives, followed by self-employed individuals and farmers, accounting for 31 out of 88 (35%), 28 out of 88 (32%), and 13 out of 88 (15%) patients, respectively. Regarding staging 39% of patients were at stage 1, 27% patients stage II, 25% patients stage IV, and 9% patients at stage III. Conclusion: CLL was the dominant type of hematological malignancies observed in Kordofan Oncology Center. beside the majority of cases were observed among males, urban residents, and elder populations aged >70 years. Special focus should be given to the highly affected population. Further more detailed studies are required in the Sudan.
Ovarian Dysgerminoma in Pregnancy: A Case Report
Normal pregnancy commonly takes an uneventful path. Emergency surgical intervention can be considered as a good chance to evaluate the hidden organs, which should not be missed. Ovarian pathology during pregnancy can be misdiagnosed as labour or gastrointestinal pathology. This is why in patients at reproductive age liaison with a gynaecologist is of great importance to avoid late presentation or misdiagnosis. Here we discuss a case of Ovarian Dysgerminoma in Pregnancy that was misdiagnosed as preterm labour with ascites. The case highlights the importance of considering rare conditions during pregnancy and the importance of multidisciplinary team and experts' advice.
Extrapulmonary Tuberculosis Mimicking Advanced Ovarian Cancer: A Case Report
Ovarian cancer represents the most prevalent cancer among females globally; the delayed diagnosis of the disease results from the absence of effective screening tools. Staging laparotomy represents the standard surgical procedure for ovarian cancer. Urogenital Tuberculosis (TB) is a manifestation of extrapulmonary tuberculosis (EPTB), accounting for approximately 4% of reported TB cases in India, whereas EPTB constitutes 20% of TB cases globally. Approximately 50% of patients who are HIV positive have this condition. In this report, a 55-year-old patient with suspected advanced ovarian cancer underwent staging laparotomy and received a pathological diagnosis of genital and peritoneal tuberculosis (TB).
Screening for Rheumatic Heart diseases among high secondary school female students at El-Obeid city, Sudan
Background and objectives: Rheumatic heart disease (RHD) remains a significant cause of cardiovascular mortality and morbidity in poor countries. It is a leading acquired cardiovascular disease among young people in low-income and middle-income countries and in some at-risk populations living in rich countries. This study aimed at determining the prevalence of RHD among secondary school female students at Ellobiid, north Kordofan, Sudan. Patients and method: The study took place from December 2017 through June 2018. An ethical clearance was obtained from the state ministry of health. Eight female secondary schools were randomly selected. In each school, a mobile echo machine was used to screen the students. The Participants were randomly selected. In this study, Pathological regurgitation is defined according to WHO criteria as follows: Mitral regurgitation jet equals or more than 2 cm, Aortic regurgitation jet equals or more than 1cm. Morphological criteria are defined as follows: For the mitral valve: anterior mitral valve leaflet thickness more than 3mm, chordae tendineae thickening, restricted leaflet motion, and excessive mitral valve leaflet tip motion in systole. For the aortic valve: Irregular thickening, coaptation defect, restricted leaflet motion and leaflet prolapse. For those with echo criteria of RHD, personal and demographic data were obtained. Cardiovascular system examination was made. A well-designed data sheet was formed and the data were then analyzed using SPSS version 18. Results: In this study, 760 students from 8 female secondary schools were examined by portable echo machine. In this cohort, 27 students were found to have RHD giving a prevalence of 36/1000.The mean age of the affected individuals was 15.9 years. The commonest valvular lesion seen was mild mitral regurgitation in 18 participants (66%), followed by mild aortic regurgitation then combination of mild mitral regurgitation and mild tricuspid regurgitation and mild aortic regurgitation and moderate mitral regurgitation respectively. Twenty participants (74%) had past history of sore throat, while 14 participants confessed to have a remote history of joint pains and fever. Most of the patients were found to have normal auscultatory findings. The only positive clinical sign was pansystolic murmur in the mitral area which was detected in 26% of the participants. Conclusion: We concluded that the use of portable Echo, is a useful technique for early detection of RHD and the prevalence of RHD in our population is moderately high compared with other studies. The application of secondary antibiotic prophylaxis (SAP), is highly recommended to reduce the incidence of RHD.
The External Examiners at Medical Schools: their Criteria, Duties and Roles
External examiners are experienced academics in higher education. The external examiner shall provide an independent overall judgement on student performance and the quality and standard of the programme, ensuring to be fair and equitable to the regulatory bodies. The external examiner also provides feedback to the programme team and institution on the overall strengths and weaknesses through a formal report.