ASSESSMENT OF CLINICAL INDICATORS FOR ANAEMIA IN THE ALGORITHM FOR INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI), WAD MEDANI PAEDIATRICS HOSPITAL, SUDAN 2001-2002

The object of this study was to assess IMCI clinical indicators used for the assessment and classification of anaemia in underfines. A total of 500 children (aged 2-59 month)were selected by systematic random method from sick children attending to the outpatient department of the paediatrics hospital in Wad Medani, Sudan. The study doctors obtained a standardized history and carried out IMCI standard case management. Heamoglobin concentration and blood smear for malaria parasites were then performed for every enrolled child. Using the WHO Hb levels to diagnose anaemia, the sensitivity and specificity of IMCI guidelines to classify anaemia were examined. The sensitivity and specificity of “ no palmar pallor” as a predictor of no anaemia were 60% and 50% respectively; and of  “some pallor” as predictor of mild-moderate anaemia were 44%, 60%; whereas  “severe pallor” showed a sensitivity of 52% and a very high specificity for 90% on detecting children with severe anaemia. Palmar pallor was not significantly associated with the presence of malaria as detected by a positive blood film for plasmodium falciparum. The study thus provides technical validation of IMCI algorithm for the assessment of anaemia. However, it did not provide proof of a significant association between palmar pallor and malaria, in the presence of fever

Knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan

Background: Cervical cancer is considered the third leading cause of death among women worldwide, and human papillomavirus was identified as a major causative agent for developing cervical cancer. Objectives: This study aimed to assess the knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan. Design: A community-based cross-sectional study implemented in Khartoum state, Sudan, from 1 August 2020 to 1 September 2020. Methods: We conducted a descriptive cross-sectional community-based study using an electronic questionnaire for data collection. Descriptive statistics, frequency, mean, and percentage were computed. Results: The study included 716 female participants with a mean age of 27.6 + 8.7 years. 580 (81.0%) and 229 (32.0%) had heard about cervical cancer and Pap test, respectively. cervical cancer was assumed related to alcohol consumption 109 (15.2%), giving birth to many children 51 (7.1%), ageing 118 (16.5%), and having many sexual partners 335 (46.8%). In addition, 300 (41.9%) attributed cervical cancer to having human papillomavirus infection, 256 (35.6%) to the prolonged use of contraceptives, and 162 (22.6%) to smoking. Knowledge about the best time to be vaccinated against human papillomavirus, 110 (15.4%) stated it is better after marriage. Regression models to predict the effectors on participants’ knowledge and attitudes showed a low standard deviation of the estimates with higher values of the adjusted R2 [R: 0.041, 0.017, and 0.006; std: 1.527, 0.417, and 0.426]. This indicates the combined influence of occupation, educational level, family income, and marital status on the participant’s knowledge and attitude levels. Conclusion: This study revealed that the participant’s knowledge and attitudes levels are mainly driven by their occupation, educational level, family income, and marital status altogether. This underscores the need for a countrywide community engagement campaign through health education and raising awareness sessions, and massive social media to sensitize the community and healthcare providers about the risk of cervical cancer and the available prevention and control measures.</p

Knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan

Background: Cervical cancer is considered the third leading cause of death among women worldwide, and human papillomavirus was identified as a major causative agent for developing cervical cancer. Objectives: This study aimed to assess the knowledge and attitudes towards cervical cancer prevention among women in Khartoum state, Sudan. Design: A community-based cross-sectional study implemented in Khartoum state, Sudan, from 1 August 2020 to 1 September 2020. Methods: We conducted a descriptive cross-sectional community-based study using an electronic questionnaire for data collection. Descriptive statistics, frequency, mean, and percentage were computed. Results: The study included 716 female participants with a mean age of 27.6 + 8.7 years. 580 (81.0%) and 229 (32.0%) had heard about cervical cancer and Pap test, respectively. cervical cancer was assumed related to alcohol consumption 109 (15.2%), giving birth to many children 51 (7.1%), ageing 118 (16.5%), and having many sexual partners 335 (46.8%). In addition, 300 (41.9%) attributed cervical cancer to having human papillomavirus infection, 256 (35.6%) to the prolonged use of contraceptives, and 162 (22.6%) to smoking. Knowledge about the best time to be vaccinated against human papillomavirus, 110 (15.4%) stated it is better after marriage. Regression models to predict the effectors on participants’ knowledge and attitudes showed a low standard deviation of the estimates with higher values of the adjusted R2 [R: 0.041, 0.017, and 0.006; std: 1.527, 0.417, and 0.426]. This indicates the combined influence of occupation, educational level, family income, and marital status on the participant’s knowledge and attitude levels. Conclusion: This study revealed that the participant’s knowledge and attitudes levels are mainly driven by their occupation, educational level, family income, and marital status altogether. This underscores the need for a countrywide community engagement campaign through health education and raising awareness sessions, and massive social media to sensitize the community and healthcare providers about the risk of cervical cancer and the available prevention and control measures.</p

Enhancing Teaching Skills Through Short Courses: A Quantitative Review of Public Health Education in Sudan

This evaluation draws evidence on the effectiveness and outcome of learning and teaching courses that were offered to a number of teaching staff of the Academies of Health Sciences, Midwifery Schools and Centres for Continuous Professional Development in Sudan. It is based on a cross-sectional study consisting of self-administered questionnaires conducted from October 2017 to January 2018. The questionnaires were used to measure the extent to which the participants of the training courses acquired knowledge and skills and applied these skills in their jobs. Data was analysed using Excel sheets and SPSS version 21 and significant tests performed. The response rate for the self-administered questionnaire was 80%. Most of participants were females, early middle-aged, bachelor’s degree holders with more than 9 years of experience in the area of teaching health care professionals. The results are presented following the Kirkpatrick framework for evaluation of training, which was used to measure participants' reactions, learning and change of behaviour. Most of the participants were satisfied with the design and content of the course but expressed concerns regarding its duration and lack of residential facilities for course participants. Pre and post tests were used to measure learning. Comparison of the two results showed that participants gained knowledge in writing learning outcomes, although presentation skills showed no improvement following the training and the use of technology remained a challenge even after the course. In terms of application of the newly gained knowledge and skills, the findings illustrated that over 90% of the participants were satisfied with what they had learned after 3 months or more following the training course, and over 65% of the participants stated that the knowledge gained from the training remained useful. In conclusion, short courses on teaching and learning can be a valuable investment to both instructors and students. The evaluation has shown that course participants were satisfied with the training courses, gained new knowledge, and were able to apply the acquired knowledge and skills without any difficulties. It is therefore suggested to cascade these training courses to all remaining States in Sudan in order to improve the skills and capabilities of teaching staff

Molecular detection of Epstein-Barr virus among Sudanese patients diagnosed with Hashimoto’s thyroiditis

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

Molecular detection of Epstein-Barr virus among Sudanese patients diagnosed with Hashimoto’s thyroiditis

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

Overview on Juvenile Primary Fibromyalgia Syndrome

JPFS (juvenile primary fibromyalgia syndrome) is a musculoskeletal pain illness that affects children and adolescents. The intricacy of the clinical picture in JPFS has not been adequately characterized in the literature. JFMS symptoms are sometimes difficult to compare to adult fibromyalgia syndrome since many of them are "medically unexplained" and frequently overlap with other medical disorders.&nbsp; The etiology of the illness is multifaceted, with impaired central pain processing being a significant contributor. Musculoskeletal pain that is severe and pervasive is the defining symptom. Other signs and symptoms include headaches, stiffness, subjective joint swelling, sleep and mood disorders, and headaches. Multiple sensitive spots might be found during a physical examination. The diagnosis has certain criteria and is clinical. Early detection and treatment are crucial. The gold standard of care combines a variety of modalities, but most significantly, exercise and cognitive behavioral therapy. The outlook varies, and symptoms might last well into adulthood. Discussing the epidemiology, etiology, pathophysiology, clinical symptoms, diagnosis, and management of JPFS is the goal of the review

MEDICAL STUDENTS' PERCEPTIONS OF COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES: A PRE- AND POST-EXPOSURE SURVEY IN MAJMAAH UNIVERSITY, SAUDI ARABIA

Background: Evidently, Complementary and Alternative Medicine (CAM) is increasingly a recognized medical practice that efficiently uses multiple treatment therapies and techniques in promoting the health and wellbeing of people as well as preventing and managing a variety of human disorders. Research in CAM, which courses exposure to diverse healthcare professionals, is important from many perspectives including improvement in teaching skills of faculty, enhancing capacity building, and innovative curriculum development. This pre- and post-design crosssectional study aimed to assess perceptions, training needs, personal usage, use in office practice, and knowledge of two batches of medical students toward CAM therapies in Majmaah University, Saudi Arabia. Materials and Methods: The second year medical students of the first (year 2012-13) and second (year 2013-2014) batch [n=26 & 39, respectively] were selected for this study. A reliable 16-item self-administered questionnaire was distributed among all students for answering before and after the 48-hour specific 19 CAM therapies course, in terms of CAM therapies are clearly conventional or alternative, training needs, effectiveness, personal use, use in practice, management of two clinical cases by CAM or conventional therapies, and views about which evidence based approach strongly support individual CAM modalities. Results: Medical students' knowledge and perceptions of CAM therapies significantly improved across some sub-items of CAM questionnaire with a positive trend in the rest of its items including their views about CAM therapies, need for further training, personal use of therapies and advising patients regarding CAM practices strongly supported by randomized clinical controlled trials and published case studies. Conclusion: CAM course tends to have positive impact on the knowledge and perceptions of medical students, in addition to need for further training, and personal use and use of CAM therapies in practice in line with strong evidence-based data regarding therapeutic efficacy. The preliminary results of this study call for further research in specific CAM modalities with a larger sample in academic settings across the nation

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely