Gunshot Injuries: Patterns, Presentations, and Outcomes of Civilian Hospital Experiences in a Developing Country Setting

Background: Gunshot injuries are considered a health burden as well as one of the intricate emergencies in civilian medical practice. In this study, we aim to determine the pattern of presentation and management outcome in a general hospital setting in a sub-Saharan African country.Methods: This is a retrospective, hospital-based study conducted between January 2015 and December 2019 in a general teaching hospital to review the clinical presentation and management outcome of gunshot injuries. All patients’ records were reviewed during the study period.Results: The total number of patients involved in the study was 157 with 83% male predominant. About 50% were from the age group 20–29 years that were most affected. The commonest anatomical site affected in the study was the lower limb (41.4%) and upper limb (22.9%), and most of the patients had been diagnosed with limb fractures (49.7%) and soft tissue injuries (28.7%). Wound debridement is the commonest procedure performed for 91 (58.0%) patients. The site of the pullet has a significant relation to the management outcome with a P-value of 0.002. Additionally, about 45% (72 patients) have stayed more than 20 days and it was affected significantly by the types of treatment provided, which has a significant relation to a hospital stay with a P-value of 0.00.Conclusion: Most of the patients in this study were young males. Upper and lower limb fractures were the most common presentations. Wound debridement, bone fixation, and laparotomy were the most common treatments with significant success rates, despite prolonged hospital stays

Review of Plastic and Reconstructive Surgery in a General Hospital Setting: Experience from a Developing Country

Background: Plastic and reconstructive surgery in developing countries and underserved areas are significantly limited and face changes to start a proper service. This study presents a review of plastic surgery services and experiences in a district hospital located in an underserved area.Methods: This descriptive, retrospective, hospital-based study was conducted to review patients who presented to the plastic and reconstruction departments from January 2014 to January 2015. All patients seen in the outpatient clinic or emergency departments for plastic surgical consultation or management were included in the study.Results: The total of 403 cases fulfilled the inclusion criteria. The emergency surgical operation performed in our unit were distributed in the following descending order; fingertip injury (32%), cut wrist (12.7%), cut extensor tendon (9.9%), gunshot injuries (9.4%), fracture of a small bone of the hand (8.3%), and lower limb trauma. Surgery for congenital deformities constituted the most elective operation done in our unit (31.6 %), followed by tumor surgery (18.7%), burn surgery (17.3%), aesthetic surgery procedure (12.2%), and other miscellaneous cases (12.2%).Conclusion: This report demonstrates the efficacy of secondary hospital setting to accommodate a large volume of patients during the first year of establishment, and further predicting development needs, staff training, and governmental support

INTESTINAL OBSTRUCTION IN CHILDREN AT EL OBEID HOSPITAL, WESTERN SUDAN.

Background: Intestinal obstruction is a common cause of childhood surgical emergency in the developing countries with considerable morbidity and mortality. Objectives: To assess the magnitude, pattern and management outcomes of intestinal obstruction in children presenting to a General Surgical Unit at a rural setup, in Western Sudan. Patients and Methods: The clinical records of all children below 15 years of age admitted to the University General Surgical Unit at El Obeid Teaching Hospital, in Western Sudan with the diagnosis of intestinal obstruction during the period from 2006 to 2007 were retrospectively reviewed. The mean age, gender, causes of obstruction and management outcomes were studied and analyzed. Results: There were 72 patients.  48 were males (66.7%). Neonates and infants were 70% of patients. Hirschsprung’s disease, intussusception, obstructed hernias and ano-rectal anomalies accounted for 21.8%, 19.4%, 16.7% and 13.9% respectively. Less common causes were pyloric stenosis 8.3% and gut atresia 6.9%. Lymphoma, adhesions, peritonitis and faecal impaction were 2% each. The overall mortality rate was 13.9%. Conclusions: The main causes of childhood intestinal obstruction at Western Sudan were congenital anomalies in neonates, intussusception in infants and obstructed hernias in elder children. The management was associated with high mortality due to poor hospital facilities and late presentations resulting in bowel ischaemia

Traditional Underground Grain Storage in Clay Soils in Sudan Improved by Recent Innovations

In the central clay plain of the Sudan, traditional subsistence farmers and small farmers that also produce for local markets want to keep the region near food self-sufficiency. They combine annual production of sorghum with underground pit storage of part of the harvest. With increasing climate variability this food security is coming more and more under pressure. Farmers recently experimented with pit innovations that would allow storage for more than one season. These innovations were quantified and further improvements were suggested. It was found that in the most abundantly occurring cracking clay soils, wide shallow pits, using thick chaff linings, with wider above ground soil caps, are most suitable for longer term storage

SERUM ZINC LEVELS IN SUDANESE PATIENTS WITH ACUTE LYMPHOCYTIC LEUKEMIA

Background: Zinc acts as growth protector for neoplastic cells and its deficiency was contributed to carcinogenesis. However, the determinations of serum zinc in acute lymphocytic leukemia (ALL) prediction and prognosis requires more investigations. Objective: To evaluate and compare serum zinc in ALL patients and healthy controls and to correlate the serum zinc levels with hematological prognostic markers. Materials and methods: The study was conducted in Khartoum state-Sudan during the period from December 2013 to September 2014, it involved a case group of ALL patients (N=100) matched for age and gender with a control group (N=100). Serum copper and zinc levels and full blood count were investigated. Results: The ALL patients showed lower levels of Zn 0.73 ± 0.18 mg/dl compared to controls 1.01 ± 0.25 mg/dl [P = 0.003]. The serum Zn levels were inversely correlated with total white cell (-0.804, P < 0.0001) and blast counts (-0.935, P < 0.0001). Conclusion: These findings ALL associated with lower serum zinc levels and higher serum copper levels. The determination of serum zinc and copper could be used as ALL prognostic markers. KEYWORDS: Acute lymphoblastic leukemia; Zinc; Carcinogenesis

SERUM ZINC LEVELS IN SUDANESE PATIENTS WITH ACUTE LYMPHOCYTIC LEUKEMIA

Background: Zinc acts as growth protector for neoplastic cells and its deficiency was contributed to carcinogenesis. However, the determinations of serum zinc in acute lymphocytic leukemia (ALL) prediction and prognosis requires more investigations. Objective: To evaluate and compare serum zinc in ALL patients and healthy controls and to correlate the serum zinc levels with hematological prognostic markers. Materials and methods: The study was conducted in Khartoum state-Sudan during the period from December 2013 to September 2014, it involved a case group of ALL patients (N=100) matched for age and gender with a control group (N=100). Serum copper and zinc levels and full blood count were investigated. Results: The ALL patients showed lower levels of Zn 0.73 ± 0.18 mg/dl compared to controls 1.01 ± 0.25 mg/dl [P = 0.003]. The serum Zn levels were inversely correlated with total white cell (-0.804, P < 0.0001) and blast counts (-0.935, P < 0.0001). Conclusion: These findings ALL associated with lower serum zinc levels and higher serum copper levels. The determination of serum zinc and copper could be used as ALL prognostic markers. KEYWORDS: Acute lymphoblastic leukemia; Zinc; Carcinogenesis

Mental illness stigma as a moderator in the relationship between religiosity and help-seeking attitudes among Muslims from 16 Arab countries

Background: Determining the potential barriers responsible for delaying access to care, and elucidating pathways to early intervention should be a priority, especially in Arab countries where mental health resources are limited. To the best of our knowledge, no previous studies have examined the relationship between religiosity, stigma and help-seeking in an Arab Muslim cultural background. Hence, we propose in the present study to test the moderating role of stigma toward mental illness in the relationship between religiosity and help-seeking attitudes among Muslim community people living in different Arab countries. Method: The current survey is part of a large-scale multinational collaborative project (StIgma of Mental Problems in Arab CounTries [The IMPACT Project]). We carried-out a web-based cross-sectional, and multi-country study between June and November 2021. The final sample comprised 9782 Arab Muslim participants (mean age 29.67 ± 10.80 years, 77.1% females). Results: Bivariate analyses showed that less stigmatizing attitudes toward mental illness and higher religiosity levels were significantly associated with more favorable help-seeking attitudes. Moderation analyses revealed that the interaction religiosity by mental illness stigma was significantly associated with help-seeking attitudes (Beta =.005; p \u3c.001); at low and moderate levels of stigma, higher religiosity was significantly associated with more favorable help-seeking attitudes. Conclusion: Our findings preliminarily suggest that mental illness stigma is a modifiable individual factor that seems to strengthen the direct positive effect of religiosity on help-seeking attitudes. This provides potential insights on possible anti-stigma interventions that might help overcome reluctance to counseling in highly religious Arab Muslim communities

Cross-cultural comparison of mental illness stigma and help-seeking attitudes: a multinational population-based study from 16 Arab countries and 10,036 individuals

BackgroundThere is evidence that culture deeply affects beliefs about mental illnesses\u27 causes, treatment, and help-seeking. We aimed to explore and compare knowledge, attitudes toward mental illness and help-seeking, causal attributions, and help-seeking recommendations for mental illnesses across various Arab countries and investigate factors related to attitudes toward help-seeking.MethodsWe carried out a multinational cross-sectional study using online self-administered surveys in the Arabic language from June to November 2021 across 16 Arab countries among participants from the general public.ResultsMore than one in four individuals exhibited stigmatizing attitudes towards mental illness (26.5%), had poor knowledge (31.7%), and hold negative attitudes toward help-seeking (28.0%). ANOVA tests revealed a significant difference between countries regarding attitudes (F = 194.8, p \u3c .001), knowledge (F = 88.7, p \u3c .001), and help-seeking attitudes (F = 32.4, p \u3c .001). Three multivariate regression analysis models were performed for overall sample, as well as Palestinian and Sudanese samples that displayed the lowest and highest ATSPPH-SF scores, respectively. In the overall sample, being female, older, having higher knowledge and more positive attitudes toward mental illness, and endorsing biomedical and psychosocial causations were associated with more favorable help-seeking attitudes; whereas having a family psychiatric history and endorsing religious/supernatural causations were associated with more negative help-seeking attitudes. The same results have been found in the Palestinian sample, while only stigma dimensions helped predict help-seeking attitudes in Sudanese participants.ConclusionInterventions aiming at improving help-seeking attitudes and behaviors and promoting early access to care need to be culturally tailored, and congruent with public beliefs about mental illnesses and their causations

Impact of Ramadan focused education program on hypoglycemic risk and metabolic control for patients with type 2 diabetess

Background: Fasting during the month of Ramadan could lead to acute complications and increased hypoglycemic risk of patients with type 2 diabetes. Therefore, diabetes is one of the diseases that need careful observation and special considerations during Ramadan including patients’ education and counseling. Objectives: To evaluate the impact of Ramadan focused education program on acute complications and biomedical parameters. Methods: A prospective nonrandomized interventional controlled design was run on three phases: before, during, and after Ramadan on 262 type 2 diabetes patients. The intervention group (n=140) received focused individualized diabetic education sessions and antidiabetic medications adjustment before and after Ramadan, while the control group (n=122) received standard diabetic care. A validated hypoglycemia questionnaire was used in both groups to assess the change of the risk. Patients were advised to adjust the dosage and timing of antidiabetic agents according to the recommendations for management of diabetes during Ramadan. Primary outcomes were postintervention change of hypoglycemia score and HbA1c over 6-month follow-up. Data were presented as mean ± standard deviation. HbA1c was expressed in percentage. Results: The hypoglycemic scores before, during, and after Ramadan were 14.21±8.50, 6.36±6.17, and 5.44±5.55 in the intervention group, respectively (P,0.001) and 14.01±5.10, 13.46±5.30, and 9.27±4.65 in the control group, respectively (P,0.001). HbA1c levels were 9.79±1.89, 8.26±1.54, and 8.52±1.61 before, during, and after Ramadan in the intervention group, respectively (P,0.001), and 10.04±1.47, 9.54±1.38, and 9.59±1.79 in the control group, respectively (P,0.001). Post-Ramadan reductions of HbA1c and hypoglycemic scores were significantly higher in the intervention group (-13.0% vs -4.5%, P=0.004 for HbA1c and -61.7% vs -33.8%, P,0.001 for hypoglycemic score). Low-density lipoprotein cholesterol improved in the intervention group from 2.41±0.91 mmol/L before Ramadan to 2.28±0.68 mmol/L after Ramadan (P,0.001). No statistically significant effects were observed on blood pressure or body weight in the intervention group. Also, no change was observed in the control group. Conclusion: Ramadan educational program had a positive impact with reduction of hypoglycemic risk, HbA1c, and low-density lipoprotein cholesterol. Therefore, it could be recommended for patients with increased risk of hypoglycemia during Ramadan fasting

Mycobacterium avium subsp. paratuberculosis and microbiome profile of patients in a referral gastrointestinal diseases centre in the Sudan

Mycobacterium avium subsp. paratuberculosis (MAP) causes Johne’s disease in animals with zoonotic potential; it has been linked to many chronic diseases in humans, especially gastrointestinal diseases (GID). MAP has been extensively studied in Europe and America, but little reports were published from Africa. Sudan is a unique country with close contact between humans and livestock. Despite such interaction, the one health concept is neglected in dealing with cases of humans with GID. In this study, patients admitted to the reference GID hospital in the Sudan over a period of 8 months were screened for presence of MAP in their faeces or colonic biopsies. A total of 86 patients were recruited for this study, but only 67 were screened for MAP, as 19 did not provide the necessary samples for analysis. Both real-time PCR and culture were used to detect MAP in the collected samples and the microbial diversity in patients´ faecal samples was investigated using 16S rDNA nanopore sequencing. In total, 27 (40.3%) patients were MAP positive: they were 15 males and 12 females, of ages between 21 and 80 years. Logistic regression analysis revealed no statistical significance for all tested variables in MAP positive patients (occupation, gender, contact with animal, milk consumption, chronic disease, etc.). A unique microbiome profile of MAP-positive patients in comparison to MAP-negative was found. These findings suggest that a considerable proportion of the population could be MAP infected or carriers. Therefore, increase awareness at community level is urgently needed to decrease the risk of MAP at human/animal interface. This study represents the first report of MAP in humans in the Sudan; nevertheless, a better view of the situation of MAP in humans in the country requires a larger study including patients with other conditions.Additional co-authors: Ahmad Amanzada, Kamal H. Eltom , ElSagad Eltaye