Ectopic Thyroid Presenting as a Sublingual Mass in a Sudanese Girl

Although extremely rare, the presence of ectopic thyroid tissue in the sublingual region should be considered in the differential diagnosis of masses in the cervical region. Diagnosis is confirmed by Fine-needle Aspiration\Biopsy Cytology and exclusion of malignancy by histopathologic analysis of the lesion. In general, surgery should not be attemptrd before radioisotope scan is obtained as this might be the only functioning thyroid tissue.  This is a rare case of ectopic thyroid in the sublingual region reported in a Sudanese girl; it was diagnosed after radioisotope thyroid scan and proved to be the only functioning thyroid tissue. &nbsp

The Performance of Candidates in the Examinations of the Otorhinolaryngology Specialty, Sudanese National Board of Medical Specializations

Introduction: The Otorhinolaryngology, Head and Neck Surgery Council is one of the first established councils of the Sudanese National Board of Medical Specializations (SNBMS).This report covers the fourth rotation period from 2009-2013. It is meant to be in the form of an analytical study for more objectivity and transparency and to be a model for promotion of the general performance of other councils in administrative, examination and training issues. Objectives: The main objective of this study is to analyze the trainees’ results in part 1 and part 2 (final) examinations with regard to gender and pass rates and to draw relevant indices that help in planning for training and expansion of specialist services. Materials and Methods: This is an analytical retrospective study conducted at the (SNMSB) headquarters Khartoum, Sudan during the period from January 2009- December 2012 .This study covers the fourth rotation of the scientific council for the specialty. The study included all candidates sitting for both part 1 and part 2 examinations (265). Candidates were classified according to gender and pass rates. Candidates who withdrew form the program after passing the part 1 examination were excluded. Results:  The total number of doctors sitting for part 1 examinant was 207. Females were 118 and males were 89. Female to male ratio was 1.3:1.0. Sixty nine (69) doctors passed the examination with over all pass percentage of 33.3%. The percentage of passed candidates among females was 31% and among males was 36%. The total number for trainees sitting for the final examination was 58. Females were 23 and males were 35. Female to male ratio was 1.0: 1.5. Thirty three (33) trainees passed the examination with over all pass percentage of 56.9%. The percentage of passed trainees among females was 52.2% and among males was 60%. The annual number of doctors sitting for part 1 examination showed marked reduction from 69 in the first year to 48 in the fourth year although there was a steady increase in-between. The average annual pass rate for part 1 examination showed noticeable increase from 23% to 42% by the end of the fourth year. The annual number of trainees sitting for the final examination was fluctuating and the biggest number was in the first year. There was a minimal increase in the number of graduates.  Conclusions: Applicants for part one examination are mostly females. Applicants numbers are generally decreasing. The pass percentages are increasing in both parts of the examination. Males performance in both part one and part two examinations is better than females. The number of graduates does not satisfy the national needs for specialist services provision and expansion

Aerobic bacteria in safe type chronic suppurative otitis media in Gezira State, Sudan

Chronic suppurative otitis media (CSOM) is a challenging disease with a high burden on society in developing countries. Information regarding CSOM in Sudanese patients is scarce. This study aimed to identify aerobic bacteria involved in CSOM and to determine their sensitivity towards commonly prescribed antibiotics. A multi-center prospective cross sectional study was conducted between June 2012 and October 2013 in private and public ENT clinics in Gezira State, Sudan. The study included 217 CSOM patients most of whom were males or had unilateral disease. The most common isolates were Staphylococcus aureus (42.6%), Klebsiella pneumoniae (14.7%), Pseudomonas aeroginosa (12.5%) and Proteus mirabilis (10.2%). The sensitivity of all isolates was highest towards gentamicin and ciprofloxacin while multiple drug resistance was prominent towards amoxyclav, cotrimoxazole, cefuroxime, cefaclor and ceftriaxone. Ciprofloxacin and gentamicin appear to be the best choices for empiric therapy in patients with CSOM. In contrast, the use of amoxyclav, cotrimoxazole, cefuroxime, cefaclor and ceftriaxone should be discouraged.Keywords: Aerobic bacteria, Chronic suppurative otitis media, Gezira State, Sudan

Common Ear, Nose & Throat Problems in the Under- Five Sudanese Children

Introduction: The health problems of children and especially the under-5 years are of great concern and impact on both medical and surgical practice. No wonder they attract political and administrative concern Objective: This study aims to identify the common Ear, Nose & Throat (ENT) problems of under-5 Sudanese children and to study the frequency, admissions, available beds and operations and to compare this work load with the rest of the ENT wards. Furthermore, to outline what is needed to improve the services for this age group. Methodology: This is a retrospective hospital–based study including all patients (n=21384) who presented to the ENT department, Wad-Medani Hospital, Gezira, Sudan, during a period of two years from the first of January 2010 to the thirty first of December 2011. Results: The total number of the under-5 children was 2330; which contributed to 41.32% of total paediatric age group, up to 16 years, (n=5639) and 10.90% of the total number of ENT patients who presented to the ENT department at Wad-Medani Hospital. The total number of admissions of under-5 children accounted for 32.72% of all paediatric patients and 20.66% of all ENT patients. Their commonest problems found in this study were; adenoiditis & tonsillitis (37.68%), otitis media (27.25%), Upper respiratory tract infections (URTIs) & allergy (12.31%), foreign body related (12.23%), otitis externa (5.45%), others (3.43%), epistaxis (0.75%), hearing & speech disorders (0.90%). The total number of children under-5 requiring surgical operations constituted 55.46% of all paediatric patients and 33.98% of the total number of all ENT patients who were operated on. Of these operations 57.01% were elective and 42.99% were emergency operations. The main indications in 94.77% of the elective operations were adenoidectomy & tonsillectomy, while most of the surgical emergencies 91.32% were due to foreign body related problems. Conclusions: The ENT problems of the under-5 children in Wad-Medani General Hospital constitute an obvious high proportion of the work load. More attention is to be paid to this age group in terms of facilities, staff training and special requirements needed in settings and equipments. Thus, better handling and outcomes could be achieved for this important and delicate age group

Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan

BACKGROUND: Chronic respiratory diseases (CRDs) greatly contribute to worldwide mortality. Despite new data emerging from Africa, prevalence estimates and determinants of CRDs in rural settings are limited. This study sought to extend the existing research conducted in urban Sudan by conducting a rural comparison. METHODS: Participants aged ≥18 years (n = 1,850), living in rural Gezira State completed pre-and post-bronchodilator spirometry and a questionnaire. Prevalence of respiratory symptoms and spirometric abnormalities were reported. Regression analyses were used to identify risk factors for CRDs. RESULTS: Prevalence of chronic airflow obstruction (CAO) was 4.1% overall and 5.5% in those aged ≥40 years. Reversibility was seen in 6.4%. Low forced vital capacity (FVC) was seen in 58.5%, and at least one respiratory symptom was present in 40.7% of the participants. CAO was more common among people aged 60-69 years (OR 2.07, 95% CI 1.13-3.82) and less common among highly educated participants (OR 0.50, 95% CI 0.27-0.93). Being underweight was associated with lower FVC (OR 3.07, 95% CI 2.24-4.20). CONCLUSIONS: A substantial burden of CRD exists among adults in rural Sudan. Investment in CRD prevention and management strategies is needed

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Prevalence and determinants of chronic respiratory diseases in adults in rural Sudan

BACKGROUND: Chronic respiratory diseases (CRDs) are considered a significant cause of morbidity and mortality worldwide, although data from Africa are limited. This study aimed to determine the prevalence and determinants of CRDs in Khartoum, Sudan. METHODS: Data were collected from 516 participants aged ≥40 years, who had completed a questionnaire and undertook pre- and post-bronchodilator spirometry testing. Trained field workers administered the questionnaires and conducted spirometry. Survey-weighted prevalence of respiratory symptoms and spirometric abnormalities were estimated. Regression analysis models were used to identify risk factors for chronic lung diseases. RESULTS: Using the Third National Health and Nutrition Examination Survey, 1988–1994 (NHANES III) reference equations, the prevalence of chronic airflow obstruction (CAO) was 10%. The main risk factor was older age, 60–69 years (OR 3.16, 95% CI 1.20–8.31). Lower education, high body mass index and a history of TB were also identified as significant risk factors. The prevalence of a low forced vital capacity (FVC) using NHANES III was 62.7% (SE 2.2) and 11.3% (SE 1.4) using locally derived values. CONCLUSION: The prevalence of spirometric abnormality, mainly low FVC, was high, suggesting that CRD is of substantial public health importance in urban Sudan. Strategies for the prevention and control of these problems are needed