Prevalence and Clinical Presentations of Dilated Cardiomyopathy in Sudanese patients with Heart Failure.

BackgroundIdiopathic dilated cardiomyopathy (DCM) is a heart muscle disease of undefined cause that commonly presents as congestive cardiac failure. The etiology of weakness of the heart muscle is often unknown, but many causal factors had been identified. The aim of this study was to determine the prevalence and clinical presentations of dilated cardiomyopathy in Sudanese patients with heart failure.MethodA prospective hospital-based observational study was undertaken during the period of January to April 2007 in two teaching hospitals namely Academy Charity Teaching Hospital and Shaab Teaching Hospital. All patients diagnosed by the physician to have heart failure were included in the study after their well informed consent and the consent of their treating physician. A standardized questionnaire developed by the researcher was used to collect data on patients socio-demographic characteristics, results of clinical, laboratory and radiography exams. All data were analyzed through the Statistical package for Social Sciences. Significance testing of difference between proportions was conducted using the Chi-square test were applicable, adjusted by Pearson's or Fisher's exact test, depending on the number of observations, with a value corresponding to p <0.05 for significance unless otherwise.ResultsOf the 72 patients in the study, 53.0% were males and 47.0% were females. The prevalence of DCM was found to be 43.1% (31 out of 72 heart failure patients). The prevalence was higher in males than females with a prevalence of respectively 47.4% and 38.2%. There was no significant difference in gender distribution of DCM (p=0.4). DCM affected older age with a mean age of 55.4 years (SEM=2.5). Palpitations, severe grade of dyspnea (grade 3 and 4), raised jugular venous pressure and cardiomegaly were the most frequent clinical presentations. The mean ejection fraction in DCM was found to be 36.7 (SEM=1.4).ConclusionContrary to common belief among clinicians in Sudan DCM is one of the commonest causes of heart failure. Its prevalence called up a best practice among clinicians, in particular those practicing in emergency units

Onchocerciasis in Sundus area: Skin and Eye manifestation

Background Onchocerciasis is known in Sudan since 1933. It, now, prevails in three foci: southern, northern and eastern focus (Sundus area). Sundus area was studied last time in mid 1980s. The actual status of the disease in Sundus area was not clear, because some villages to be hyper-endemic at that time, were abandoned and the population resettled in other areas. Objectives This study was designed to provide the actual information of skin and eye lesions due to onchocerciasis, in Sundus area, eastern Sudan. Methodology Two clinics were setup in the area, and all individuals coming to these clinics were included in the study. They were subjected to physical examination for dermatological changes and ophthalmic examination using slit lamp biomicroscope and direct ophthalmoscope. Results Total number of 302 individuals was examined, of which 87 individuals (28.8%) were found to have onchocercal skin disease. The commonest type was lichenified onchodermatitis (18.5%) and chronic papular onchodermatitis (11.6%). The localized onchodermatitis (Sowda) was seen in 19 subjects. No case of blindness was recorded; however, ocular changes were seen in 43 individuals (14.2%) including corneal opacity and cataract. Conclusion Results of this study provide support for the still existence of the disease in Sundus area. Key words: Onchocerciasis, onchodermatitis, Sundus, onchocercal eye disease. Sud. j. dermatol Vol.2(1) 2004: 20-2

From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in sudan

Background: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium-ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods: The authors (all members of the global partnership) reflect on the project in one of its\u27 partner countries, Sudan, over its\u27 five year duration. This reflection is supported by specific project data collected over the period of the project (2008-2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. Results: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan\u27s health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph. D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. Conclusion: We surmise that the \u27network of action\u27 approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network

Causes of end stage renal failure among haemodialysis patients in Khartoum State/Sudan

BACKGROUND: End stage renal failure (ESRF) has become a major health problem in Sub Saharan Africa (SSA). There were limited data about causes of ESRF in the Sudan. METHODS: This is a cross sectional hospital based descriptive study. The subjects of the study are ESRF adults’ patients on regular haemodialysis treatment in 15 haemdoialysis centres in Khartoum State—Sudan. Clinical and epidemiological data were obtained from 1583 patients. The medical files of each patient were reviewed to identify the cause of ESRF. Concerning the causes of ESRF, diabetes was diagnosed based on the past medical history and result of the glucose tolerance test, hypertension was diagnosed based on past history of hypertension based on blood pressure of more than 140/90 mmHg, glomerulonephritis was diagnosed based on results of previous kidney biopsies and on clinical grounds, polycystic kidney disease and obstructive uropathy were diagnosed based on abdominal ultrasound and other imaging modalities, sickle cell anaemia was diagnosed based on the result of haemoglobin electrophoresis, systemic lupus erythematosus was diagnosed based on the clinical criteria in addition to lab results of auto antibodies, and analgesic nephropathy was diagnosed based on past medical history of chronic analgesic drugs usage with no other identifiable risk factors. We included all ESRF patients on regular haemodialysis treatment. We excluded ESRF patients less than 18 years old. RESULTS: The results showed that the mean age of ESRF Patients was 49 ± 15.8 (years) and 63.4 % were male and 76.3 % were unemployed. The mean duration of haemodialysis is 4.38 ± 4.24 (years). The most common cause of ESRF in our patients was hypertension (34.6 %) followed by chronic glomerulonephritis (17.6 %), diabetes mellitus (12.8 %), obstructive uropathy (9.6 %), autosomal dominant poly cystic kidney disease (ADPKD) (4.7 %), chronic pyelonephritis (4.6 %), analgesic nephropathy (3.5 %). However in (10.7 %) no cause was found. In patient aged less than 40 years old the leading cause of ESRF was glomerulonephritis (29.3 %) followed by hypertension (25 %). In patient aged between 40 to 60 years old the leading cause of ESRF was hypertension (38.5 %) followed by diabetes mellitus (14 %). In patient aged older than 60 years the leading cause of ESRF was hypertension (38.4 %) followed by diabetes mellitus (23.3 %). CONCLUSIONS: ESRF in Sudan affects the economically productive age group; unemployment rate among ESRF patients is high. The study showed that hypertension is a leading cause of ESRF in Sudan followed by chronic glomerulonephritis. Hypertension and diabetes mellitus are the leading causes of ESRF among patients over 40 years old

The effectiveness of anti-inflammatory and anti-seizure medication for individuals with single enhancing lesion neurocysticercosis: A meta-analysis and expert group-based consensus recommendations.

Single brain enhancing lesions (SEL) are the most common presentation of neurocysticercosis (NCC) observed on neuroimaging in people presenting with epileptic seizures not only on the Indian sub-continent and in travelers returning from cysticercosis-endemic regions, but are also present in other parts of the world. The aim of this study, which consisted of a systematic review (CRD42019087665), a meta-analysis and an expert group consultation, was to reach consensus on the best anti-seizure medication and anti-inflammatory treatment for individuals with SEL NCC. Standard literature review methods were used. The Cochrane risk of bias tool was used and random effects model meta-analyses were performed. The quality of the body of evidence was rated using GRADE tables. The expert committee included 12 gender and geographically balanced members and recommendations were reached by applying the GRADE framework for guideline development. The 1-1.5-year cumulative incidence of seizure recurrence, cyst resolution or calcification following anti-seizure medication (ASM) withdrawal was not statistically different between ASM of 6, 12 or 24 months. In contrast, in persons whose cyst calcified post treatment, longer ASM decreased seizure recurrence. The cumulative incidence ratio (CIR) 1-1.5 years after stopping ASM was 1.79 95% CI: (1.00, 3.20) for patients given 6 versus 24 months treatment. Anti-inflammatory treatment with corticosteroids in patients treated with ASM compared to patients treated with ASM only showed a statistically significant beneficial effect on seizure reduction (CIR 0.44, 95% CI 0.23, 0.85) and cyst resolution (CIR 1.37, 95%CI: 1.07, 1.75). Our results indicate that ASM in patients with SEL NCC whose cysts resolved can be withdrawn, while patients whose cysts calcified seem to benefit from prolonged anti-seizure medication. Additional corticosteroid treatment was found to have a beneficial effect both on seizure reduction and cyst resolution

Review of 2022 World Health Organization guidelines on the control and elimination of schistosomiasis

Schistosomiasis is a helminthiasis infecting approximately 250 million people worldwide. In 2001, the World Health Assembly (WHA) 54.19 resolution defined a new global strategy for control of schistosomiasis through preventive chemotherapy programmes. This resolution culminated in the 2006 WHO guidelines that recommended empirical treatment by mass drug administration with praziquantel, predominately to school-aged children in endemic settings at regular intervals. Since then, school-based and community-based preventive chemotherapy programmes have been scaled-up, reducing schistosomiasis-associated morbidity. Over the past 15 years, new scientific evidence—combined with a more ambitious goal of eliminating schistosomiasis and an increase in the global donated supply of praziquantel—has highlighted the need to update public health guidance worldwide. In February, 2022, WHO published new guidelines with six recommendations to update the global public health strategy against schistosomiasis, including expansion of preventive chemotherapy eligibility from the predominant group of school-aged children to all age groups (2 years and older), lowering the prevalence threshold for annual preventive chemotherapy, and increasing the frequency of treatment. This Review, written by the 2018–2022 Schistosomiasis Guidelines Development Group and its international partners, presents a summary of the new WHO guideline recommendations for schistosomiasis along with their historical context, supporting evidence, implications for public health implementation, and future research needs

From local to global: a qualitative review of the multi-leveled impact of a multi-country health research capacity development partnership on maternal health in Sudan

Background: There is a substantial body of literature on the principles of good partnerships and the rationale for such partnerships in research capacity strengthening. This paper illustrates the long term effects of a multi-country (8 countries) global partnership for health systems research capacity development (Connecting health Research in Africa and Ireland Consortium - ChRAIC) in relation to its contribution to capacity strengthening, public advocacy and policy influence at different levels and its practical achievements in Sudan in addressing access to maternal health services. Methods: The authors (all members of the global partnership) reflect on the project in one of its’ partner countries, Sudan, over its’ five year duration. This reflection is supported by specific project data collected over the period of the project (2008–2014). The data collected included: (i) 6 monthly and annual donor reports; (ii) a mid-term internal and end of project independent evaluation of the entire project, and; (ii) a Ph.D study conducted by a member of the Sudanese research team. Results: The ChRAIC project in Sudan achieved the deliverables set out at the beginning of the project. These included a national knowledge synthesis report on Sudan’s health system; identification of country level health systems research priorities; research capacity assessment and skills training, and; the training and graduation of a Sudanese team member with a Ph.D. Mechanisms established in Sudan to facilitate these achievements included the adoption of culturally sensitive and locally specific research and capacity strengthening methods at district level; the signing of a Memorandum of Understanding at country level between the Ministry of Health, research and academic institutions in Sudan, and; the establishment of country level initiatives and a research unit. The latter being recognized globally through awards and membership in global health forums. Conclusion: We surmise that the ‘network of action’ approach adopted to partnership formation facilitated the benefits gained, but that adopting such an approach is not sufficient. More local and contextual factors influenced the extent of the benefits and the sustainability of the network