University of Khartoum

Wali S., Batawi G., Afeef G.B., Bamagoos A.A., Jamal A., Kanbr O., Alshumrani R., Alhejaili F., Badr M.S.

Rao M.S., Gaur A., Bharadwaj H.R., Imran S., Tan J.K., Abbas S., Fuad M., Abuhashem S., Shah M.H., Dalal P., Al Khatib A.N., Abbasher Hussien Mohamed Ahmed K.

Background: Pediatric gastroenterology (GI) care in low- and middle-income countries (LMICs) faces substantial challenges due to limited healthcare infrastructure, inadequate resources, and a shortage of specialized healthcare professionals. These challenges lead to delayed diagnoses and treatment, exacerbating the morbidity and mortality associated with pediatric GI diseases, which include both infectious conditions like diarrhea and chronic conditions such as inflammatory bowel disease (IBD) and liver diseases. Aim: The aim of this review is to examine the current state of pediatric GI care in LMICs, identify the key challenges these regions face, and propose strategies to improve healthcare outcomes for children affected by GI disorders. Methods: This review synthesizes existing literature from a range of LMICs, analyzing factors such as the economic burden of healthcare, barriers to access, the availability of diagnostic and therapeutic services, and the state of pediatric hepatology and endoscopy. Studies included in the review were sourced from countries in sub-Saharan Africa, South Asia, and other LMIC regions, focusing on pediatric GI disorders and healthcare delivery. Results: Economic burden: Families in LMICs face significant economic barriers in accessing pediatric GI care, with treatment costs often exceeding household income, especially in private healthcare settings. Healthcare access: Limited access to healthcare facilities, especially in rural areas, coupled with the shortage of trained pediatric gastroenterologists and necessary medical equipment, leads to delayed diagnoses and inadequate care for conditions like Helicobacter pylori infections and chronic liver diseases. Sanitation and infectious diseases: Poor sanitation and lack of access to clean water contribute to the high prevalence of diarrheal diseases, which can be reduced through better hygiene practices and improved infrastructure. Training gaps: The shortage of trained healthcare workers, particularly pediatric specialists, hinders effective care delivery, with healthcare workers often overburdened due to workforce migration and low salaries. Hepatology and endoscopy: Pediatric hepatology, especially in the context of viral hepatitis, and the availability of pediatric GI endoscopy are severely limited in LMICs, further complicating the management of liver diseases and GI conditions in children. Conclusion: Improving pediatric GI care in LMICs requires addressing systemic challenges such as inadequate healthcare infrastructure, limited financial resources, and a shortage of trained professionals. Prevention strategies like vaccination, sanitation improvements, and public health education campaigns are crucial for reducing the prevalence of pediatric GI diseases. In addition, enhancing access to specialized training, healthcare services, and diagnostic tools will improve outcomes for children in resource-limited settings. Continued international collaboration and investment in local healthcare systems are essential for creating sustainable solutions and bridging the gap in pediatric GI care.

Alhazmi F.H., Alrehily F.A., Alsharif W., Gameraddin M., Alsultan K.D., Alsaedi H.I., Aloufi K.M., Alshoabi S.A., Abdulaal O.M., Qurashi A.A.

Objective This study aims to investigate the long-term effects of the COVID-19 pandemic on medical imaging case volumes. Methods This retrospective study analyzed data from the Integrated Radiology Information System-Picture Archive and Communication System (RIS-PACS), including monthly medical imaging case volumes at a public hospital, spanning from January 2019 to December 2022. The study collected data on medical imaging examinations, comparing the pre COVID-19 period, which acted as a control group, with the periods following COVID-19, which were designated as cohort groups. Results The total number of medical imaging procedures performed (n = 597,645) was found significantly different (F = 6.69, P < 0.001) between 2019 and 2022. Specifically, the bone mineral density/computed radiography (BMD/CR) modality experienced a significant decrease (P = 0.01) of the procedures performed in 2020 and 2021 compared to 2019. Conversely, the nuclear medicine/computed tomography (NM/CT) and computed tomography (CT) modalities demonstrated a significant increase of the procedures performed in 2021 (P = 0.04) and (P < 0.0001), respectively, and in 2022 (P = 0.0095) and (P < 0.0001), respectively, compared to the pre-pandemic year. The digital X-ray modality (DX) showed the highest volume (67.63%) of the performed procedures overall between 2019 and 2022. Meanwhile, magnetic resonance imaging (MR) and ultrasound (US) modalities experienced a slight drop in the number of procedures in 2020—4.47% for MR and 1.00% for US, which subsequently recovered by 22.15% and 19.74% in 2021, and 24.36% and 17.40% in 2022, respectively, compared to 2019. Conclusion The COVID-19 pandemic initially led to a drop in the number of medical imaging procedures performed in 2020, with the most noticeable drop occurring during the early waves of the pandemic. However, this trend revealed a gradual recovery in the subsequent years, 2021 and 2022, as healthcare systems adapted, and pandemic-related restrictions were modified.

Alagbonsi A.I., Essop M.F., El-Wazir Y., Nyakudya T., Fastone G., Mojiminiyi F., Saeed A., Stienen G.J., Balandya E., Raji Y., Bintou Sarr F., SAMB A., Ebrahim A., Pohl U., Silverthorn D.U.

Physiology education in Africa faces challenges due to gaps in curricula across many of its universities, such as divergent content, a lack of standardized competencies, and suitable benchmarking. Here, we describe the development of Physiology Curriculum for African Universities (PhysioCAFUN), a competency-based curriculum development guideline, as a first step to address such shortcomings. A committee of 15 physiologists from different African regions, Europe, and USA was constituted to draft the PhysioCAFUN, which was introduced and revised during the joint East African Society of Physiological Sciences (EASPS) and African Association of Physiological Sciences (AAPS) conference held in Tanzania late 2023. The PhysioCAFUN consists of 23 modules. Modules 1-15 cover the organ systems, including principles and concepts of physiology, molecular biology and cell physiology. Modules 16-23 contain optional content, including environmental physiology, pharmacology, and topics related to skill development. PhysioCAFUN serves as a freely available resource document for African stakeholders regarding the desired undergraduate physiology training and competencies. It will help universities in Africa, and elsewhere, to draft a curriculum suitable for their local needs where there is a dearth of physiologists, or to benchmark and revise their curricula where physiology programs are already in place.

Elsharif S.A., Elamin M.A., Rafei A., Abdelraheem E.M., Abdo A.E.

Introduction: Choledocholithiasis is the presence of gallstones within the common bile duct (CBD), affecting 10–20% of gallbladder stone patients. Endoscopic retrograde cholangiopancreatography (ERCP) with stent insertion is a common treatment of CBD obstruction and stenosis to maintain duct patency, with stents typically replaced within 3–6 months. However, prolonged stent presence can lead to complications such as pancreatitis and cholangitis. We report a rare case of a neglected CBD stent left in situ for 14 years without complications. Case presentation: A 77-year-old female with controlled hypertension and diabetes presented to the hospital for a routine check-up. Physical examination was unremarkable except for mild scleral jaundice. She had a history of obstructive jaundice treated with ERCP and stent placement in 2010 but missed follow-ups for stent replacement. Laboratory tests revealed mildly elevated total bilirubin and low serum albumin. An abdominal ultrasound showed gallbladder sludge and a mildly dilated CBD. ERCP confirmed a dilated CBD and common hepatic duct stricture. A new plastic stent was placed, with follow-up ERCP scheduled every 6 months. Clinical discussion: Forgotten biliary stents (FBS) are plastic stents left in place for more than a year. They can cause complications such as cholangitis, jaundice, stent migration, and pancreatitis. Elderly patients are more susceptible due to physical limitations and potentially inadequate follow-up. Our case highlights the unusual presentation of an asymptomatic FBS for 14 years. Conclusion: This case emphasizes the importance of regular monitoring and timely stent replacement to prevent complications. Effective patient education and adherence to follow-up protocols are crucial in managing biliary stents.

Mahgoub Y., Khalid M., Sosal W., Pathare A.

Abstract Catatonia is a neuropsychiatric syndrome that occurs with several psychiatric and systemic medical conditions. Central nervous system abnormalities are believed to increase the risk of catatonia, with several cases reported in patients with neurodevelopmental and neurodegenerative disorders. Lissencephaly is a spectrum of neuronal migration disorders characterized by poorly defined or absent gyri and sulci, abnormally thick cortex, and a broad array of histopathological changes. Lissencephaly has a range of etiologies, clinical signs, symptoms, and degrees of severity. It is associated with comorbidities, such as epilepsy, visual, cardiac, and skeletal problems, as well as premature mortality. In this article, we describe the case of a patient with lissencephaly who developed catatonia at 20 years of age. He was minimally responsive to treatment with a high dose of lorazepam, and catatonia subsided with the use of electroconvulsive therapy. This is the first case in our knowledge to describe the occurrence of catatonia among patients with lissencephaly and its treatment with electroconvulsive therapy.

Anouar E.H., Ali Z., Filai I., Abdalla S.

Usman Younas M., Saeed A., Ramzan M., Junaid Tahir M., Abbasher Hussien Mohamed Ahmed K., Ahmed A.

Background and aims: Transarterial chemoembolization (TACE) is a significant intervention in hepatocellular carcinoma (HCC) management, but controversies persist regarding its application in advanced cases with vascular invasion or extrahepatic metastasis. This systematic review aims to explore TACE’s efficacy and safety in these cases. Methods: A literature search was conducted on TACE in HCC patients with vascular invasion or extrahepatic metastasis. The study compared TACE with surgical resection/chemotherapeutic drugs or with no group as well. Safety was assessed for adverse outcomes and efficacy, including overall survival, mean survival, and progression-free survival (PFS). Data extraction included study characteristics, patient demographics, intervention details, outcomes, and adverse events. Results: A study of 28 studies involving 3740 patients found that TACE showed diverse safety and efficacy outcomes. Safety evaluations focused on liver function tests, while patient-reported symptoms included fever, pain, vomiting, and gastrointestinal issues. Overall survival was under 10 months in 9 studies, with PFS lower in the TACE group compared to conservative treatments. Survival rates ranged from 93.4% at 3 months to 13% at 24 months across studies. The study identified potential subsets where TACE exhibited efficacy, especially in cases with favorable liver function or specific tumor classifications. Conclusion: Our findings suggest a potential role for TACE in certain subsets of advanced HCC patients. Tailored treatment algorithms, informed by rigorous clinical trials and considering various prognostic factors, hold the potential to enhance the management and outcomes for this complex patient population.

Hemmeda L., Mohammed O.A., Elgadi A., Tarig Abdalla Mohamed M., Ariss N.S., Abdel Majeed Mohamed Salih O., Mohamed Ahmed K.A.

Background. Puberty, a stage of development involving sexual maturation, is not well understood in Sudan regarding the onset and pattern of puberty in elementary school boys and girls. Objectives. To investigate the average ages and patterns of pubertal development of male and female school children. Methods. A one-year study involved 1584 students from 50 elementary schools. Result. The study involved 1584 students, with 58.6% male and 41.4% female. The minimum age for pubertal signs was 9 years. Boys showed increased height, body build, interest in adult behavior, acne, gynecomastia, pubic hair growth, axillary hair growth, facial hair growth, while girls showed increased height, breast buds, interest in adult behavior, and menarche. Conclusion. The study revealed that puberty typically begins at 9 years old in both males and females, with pubic hair development occurring before height increase in boys, breast budding and pubic hair appearing later in girls, particularly in Sudan.

Aljibori H.S., Ghalambaz M., Akremi A., Younis O., Fteiti M., Baro M., Alresheedi F.

Hussein A.K., Rashid F.L., Rasul M.K., Basem A., Younis O., Homod R.Z., Attia M.E., Al-Obaidi M., Al-Sharify Z.T., Al-Dabooni N.M., Ali B., Rout S.K.

Salih H.S., Ibrahim S.A., Gaded M.A., Osman L.A., Mahmoud M.F., Elbadawi M.H., Abdulmoniem L.A., Hummad N.H., Elbashir W.A., Ahmad D.A., Osman S.E.

The ongoing conflict in Sudan leads to widespread displacement and increased mortality, significantly impacting the mental health of populations in conflict zones. This study aims to fill the gap and assess the level of stress, depression, and anxiety among Khartoum University undergraduate students in war-afflicted regions. A cross-sectional study among 443 undergraduate students Was conducted using cluster and stratified sampling techniques. Data was collected using a valid questionnaire in a period of one month and analyzed using SPSS and a regression model to assess factors affecting distress. The study shows high levels of psychological distress, particularly among female students. Median anxiety and stress levels were 12.50 and 14.00, respectively, for women, significantly higher than those for men (p < 0.001). Faculty, physical health, time management, and support systems were also significantly correlated with distress levels. Students in the Faculty of Forests and Animal Breeding exhibited the highest levels of depression and anxiety. Poor physical health and seeking professional help were strongly associated with increased psychological distress. Regression analysis identified gender (p = 0.001) and time management (p = 0.022) as significant predictors of overall distress. Undergraduate university students in war regions experience high levels of stress, anxiety, and depression due to conflict situations. These findings reflect the urgent need for interventions such as community-based programs and counselling. We recommended future studies to explore long-term impacts on students' mental health.

Khogali R., Bastos A., Getange D., Bargul J.L., Kalayou S., Ongeso N., Verhoeven J.T., Kabii J., Ngiela J., Masiga D., Villinger J.

Ticks are blood-feeding ectoparasites that harbor diverse pathogens and endosymbionts. Their microbial communities vary based on tick species, stage, sex, geographical location, surrounding environment, and tissue type. Understanding tick microbiota at the tissue level is crucial for unraveling how microbiomes are distributed in tick tissues and influence pathogen transmission. We used V1-V2 16 S rRNA gene sequencing to analyze tissue-specific bacterial compositions (hemolymph, saliva, salivary glands, and midgut) of Amblyomma gemma, Rhipicephalus pulchellus, Hyalomma dromedarii, and Hyalomma rufipes ticks collected from camels in Marsabit County, northern Kenya. The V1-V2 region of the 16 S rRNA gene effectively differentiated 43 Rickettsia africae and 16 Rickettsia aeschlimannii tick samples from other rickettsial species, as well as Coxiella endosymbionts from Coxiella burnetii. In contrast, the V3-V4 region sequences of these species could not be clearly distinguished. Coxiella endosymbionts were most common in Am. gemma and Rh. pulchellus, while Francisella endosymbionts predominated in Hyalomma ticks; both were primarily localized in the salivary glands. High abundances of Coxiella endosymbionts, as well as Pseudomonas, were associated with the absence or low abundance of Rickettsia pathogens in both Am. gemma and Rh. pulchellus, suggesting competitive interactions between these microbes. Additionally, Proteus mirabilis, an opportunistic pathogen of the urinary tract in humans, was found predominantly in Hyalomma ticks, except for the salivary glands, which were most abundant with Francisella endosymbionts. Furthermore, we detected the Acinetobacter, Pseudomonas, and Corynebacterium genera in all the tick tissues, supporting the hypothesis that these bacteria might circulate between camel blood and ticks. Saliva and hemolymph generally harbored more extracellular bacteria than the salivary glands and midgut. This study provides a new approach to unravel tick-endosymbiont-pathogen interactions by examining the tissue localization of tick-borne pathogens and symbionts in Am. gemma, Rh. pulchellus, Hy. dromedarii, and Hy. rufipes from camels in northern Kenya. Our findings establish a baseline for developing an understanding of the functional capacities of symbionts and for designing symbiont-based control strategies.

Ahmed W.Y., Altayib L.S., Omer A.T.

Deinfibulation [opening the scar of infibulation] is a minor operation involving a vertical incision to the scar to expose the urethra and vagina. Deinfibulation may improve the quality of life for infibulated women. The quality of life after deinfibulation has been sparsely investigated. This study aims to fill this gap by evaluating the quality of life in deinfibulated women, examining the effects of deinfibulation on the urogenital system, and identifying the reasons for not performing reinfibulation. The study aimed to evaluate the quality of life in women who have undergone deinfibulation and to assess the impact of deinfibulation on the urogenital system. A descriptive cross-sectional study was conducted at Saudi Teaching Hospital in Kassala, involving 73 women who previously underwent infibulation and subsequently underwent deinfibulation. Data collection included sociodemographic information, gynecological and obstetric history, reasons for deinfibulation, reasons behind not performing reinfibulation, and assessments of complications such as urinary tract infections and sexual symptoms. Among the participants, 54.8% had female genital mutilation type III FGM, while 45.2% had female genital mutilation type IV. The percentage of women with regular menstrual cycles increased to 100% after deinfibulation. Dysmenorrhea was reported by only 9.6% of participants after deinfibulation. The prevalence of obstructed labor decreased to 1.4%. Episiotomy was performed on all women before deinfibulation, with 78.1% reporting it after deinfibulation. None of the participants had blood loss after deinfibulation. Before deinfibulation, 24.7% of women reported various sexual symptoms, while urinary tract infections were more prevalent at 87.8%. The pain was the primary reason for not undergoing reinfibulation 50.7%, and vaginal delivery was the most common reason for deinfibulation 97.3%. Deinfibulation has the potential to enhance the quality of life for women who have undergone infibulation and demonstrates positive effects on the urogenital system.

Elshaikh A., Abdo G., Salih A., Ladisa G., Bogliotti C., Sokrab I., Barsi M., Mabrouki J.

The Gezira Scheme, one of the world's largest irrigation projects, faces complex challenges in managing its water-energy-food nexus while ensuring agricultural sustainability. This study investigates the implementation of Best Management Practices (BMPs) within the scheme, focusing on soil fertility, water management, and energy efficiency. Through development of a comprehensive framework, key findings emerge regarding the importance of BMPs in enhancing agricultural productivity. Strategies such as soil enhancements, water-efficient irrigation techniques, and improved seeds adoption are identified as critical for promoting sustainable production practices within the scheme. In conclusion, sustainable agriculture practices not only ensure the long-term viability of agricultural production within the scheme but also contribute to broader societal goals such as food security, poverty alleviation, and environmental conservation.