The association of polypharmacy to diabetes distress among patients with type 2 diabetes mellitus attending an outpatient clinic in Omdurman-Sudan

Introduction: Diabetes distress and polypharmacy are causes of concern among diabetic patients. The present study assessed the association of polypharmacy to diabetes distress among patients with type 2 diabetes mellitus. Methods: A cross-sectional descriptive study conducted among 103 consecutive patients with type 2 diabetes at an outpatient clinic in Omdurman, Sudan during the period from June 2016 to September 2016. Participants signed a written informed consent, then interviewed to collect demographic data, number and type of drugs taken to assess the polypharmacy and the duration of diabetes mellitus. A blood sample was taken for fasting plasma sugar and the HbA1c. The 17-items diabetes distress scale was used to assess diabetes distress. The ethical committee of Omdurman Teaching Hospital approved the research and the Statistical Package for Social Sciences was used for data analysis. Results: They were 103 patients with type 2 diabetes, their age mean± SD (59.64 ± 9.6), the mean HbA1c was 9.91 ± 2.65, the majority (70.9%) had poor glycemic control (HbA1c > 7) and the fasting plasma sugar was above the goal recommended by the American Diabetes Association in 82.4% of the participants. Polypharmacy was observed in 31.1% of patients. No differences were found between patients on polypharmacy and those without regarding age, diabetes duration, the glycated hemoglobin and diabetes distress. Conclusion: No significant statistical difference was found between polypharmacy patients and their counterparts regarding diabetes distress score

The Best Time for Completion Thyroidectomy on Differentiated Thyroid Carcinoma: A Literature Review

Background: Completion thyroidectomy is performed for high-risk differentiated thyroid carcinoma; however, the timing of the completion  thyroidectomy is a matter of controversy. The current review aimed to assess the best time for completion thyroidectomy in patients with differentiated thyroid carcinoma.Methods: An electronic search was conducted in various databases, such as Pub Med, Google Scholar, Scopus, and Medline, for relevant articles assessing the timing of completion thyroidectomy from the first published article to October 2019. Keywords, “completion thyroidectomy” and “timing” were used. The search was limited to articles published in the English language. Among the 190 articles retrieved, only 11 fulfilled the inclusion criteria.Results: Of the 11 articles included, two were from Europe, one from Africa, one from Australia, and seven from Asia, and all were retrospective studies with the mean duration of studies being 12.71 ± 12.31 years. Five studies (45.5%) showed no effect of timing on the outcomes, two (18.2%) recommended both early and late operation, another two (18.2%) concluded that late operation is better, one (9.1%) found that early surgery is better, while one study (9.1%) stated that the timing of operation should be based on the category of the patient.Conclusions: The results were mixed with some studies recommending late completion thyroidectomy, some observing that both early and late  thyroidectomy are safe, while some finding no effect of time on the completion thyroidectomy. Welldesigned controlled trials will resolve the issue. Keywords: early completion thyroidectomy, late thyroidectomy, timing&nbsp

Fatigue, Nonrestorative Sleep and Associated Factors Among Sudanese Patients with Type 2 Diabetes: A Case-Control Study

Background: Fatigue, nonrestorative sleep, and other sleep disorders could be pointers to serious medical problems like obstructive sleep apnea; when present in patients with diabetes, they exacerbate each other deleterious consequences. The present study aimed to assess fatigue, nonrestorative sleep, sleep duration, and daytime sleepiness among patients with type 2 diabetes. Methods: This cross-sectional descriptive study was conducted among 103 consecutive patients with type 2 diabetes and 121 healthy controls attending an outpatient clinic in Omdurman, Sudan during the period from December 2015 to June 2016. All participants signed a written informed consent and were interviewed using a questionnaire based on Epworth Sleepiness Scale to assess subjective nonrestorative sleep, sleep duration, and snoring. A blood sample was taken for the HbA1c. The local ethical committee approved the research, and chi-square test and t-test were used for data analysis. Results: Highly significant statistical differences were observed between the diabetic patients and the control subjects regarding fatigue, nonrestorative sleep, sleep duration, snoring, and excessive daytime sleepiness (P-value < 0.001). Patients with fatigue had higher nonrestorative sleep than those without, no significant differences were found between patients with the symptoms of fatigue and those without regarding excessive daytime sleepiness, snoring, sleep duration, and the HbA1c (P-value > 0.05). Conclusions: Fatigue, nonrestorative sleep, sleep duration, excessive daytime sleepiness, and snoring were common among patients with type 2 diabetes than their healthy counterparts, diabetic patients with fatigue had more nonrestorative sleep than those without. The reliance on a self-administered questionnaire is a limitation of the study.  Keywords: fatigue, nonrestorative sleep, excessive daytime sleepiness, diabetes mellitus, Suda

Assessment of HIV/AIDS comprehensive correct knowledge among Sudanese university: a cross-sectional analytic study 2014

Introduction: Comprehensive correct HIV/AIDS knowledge (CCAK) is defined as correctly identify the two major ways of preventing the sexual transmission of HIV, and reject the most common misconceptions about HIV transmission. There are limited studies on this topic in Sudan. In this study we investigated the Comprehensive correct HIV/AIDS knowledge among Universities students. Methods: A cross-sectional analytic study was conducted among 556 students from two universities in 2014. Data were collected by using the self-administered pre-tested structured questionnaire. Chi-square was used for testing the significance and P. Value of ≥ 0.05 is considered as statistically significant. Results: The majority (97.1%) of study subjects have heard about a disease called HIV/AIDS, while only 28.6% of them knew anyone who is infected with AIDS in the local community. Minority (13.8%) of students had CCAK however, males showed a better level of CCAK than females (OR = 2.77) with high significant statistical differences (P. Value = 0.001). Conclusion: Poor rate of CCAK among university students is noticed, especially among females. Almost half of students did not know preventive measures of HIV, nearly two thirds had misconception, about one third did not know the mode of transmission of HIV.Pan African Medical Journal 2016; 2

The Cross-talk Relationship between Metformin and Gut Microbiota

Background: Metformin is the first-line oral therapy for type 2 diabetes mellitus. However, its mode of action is poorly defined. There is an increasing awareness regarding the cross talk of gut microbiota and metformin. The current review aimed to assess the bidirectional relationship between metformin and gut microbiota. Methods: Electronic search was conducted in Pub Med and the first 100 articles in Google Scholar published until November 2019. However, only randomized controlled trials on humans published in the English language were included.  The terms “gut microbiota,” “gut flora "and “ metformin” were as keywords to perform the search. Although 124 articles were retrieved, only six met the inclusion criteria of the study. Results: Of the six full texts of randomized controlled trials included in the study, two-thirds were published in Europe, one in the USA, and one in China. Six hundred-thirty five patients were included and the duration of the studies ranged from seven days to six months. The studies concluded that microbiota modulates some metformin actions on plasma glucose; while metformin enhances the abundance of microbiota that positively affect insulin resistance and plasma glucose. Conclusion: The current review showed that microbiota dysbiosis may mediate metformin antidiabetic effects. Whereas metformin shifted the gut microbiota toward the beneficial species ameliorating insulin resistance. The present study might provide insights into a novel therapeutic approach to treat type 2 diabetes mellitus. Key words: gut microbiota, metformin, type 2 diabete

A Case Report of Duodenal Psammomatous Somatostatinoma

Somatostatinoma is a neuroendocrine tumor; its incidence in the duodenum around the ampulla of Vater is rare, and it is often not associated with secretory manifestation. We report a case of a female with an ampullary (Vater) tumor displaying neuroendocrine nuclear features, psammoma bodies, and the positivity for immunohistochemical panel of neuroendocrine tumors. Our patient presented with some features compatible with somatostatin secretion associated syndrome; albeit with normal serum levels of the hormone. Initial attempt of complete resection failed, and the involved margins were revised with a subsequent surgery, and the patient showed an uneventful course on follow-up for 2 years

Hypopharyngeal Leishmaniasis: A case Report and Literature Review.

Background: Leishmaniasis is classified into three clinical patterns: visceral, cutaneous and mucocutaneous.The latter are sporadically reported in Sudan and may not accompany the visceral type. Laryngeal symptoms including dysphagia may mimic oesophageal malignancy. Early detection and proper diagnosis are of great help in the cure and prognosis of the disease. Case report: We reported a case of primary isolated (the nasal mucosa was not involved) Hypophangeal Leishmaniasis in an immunocompetent Sudanese patient presenting with dysphonia, odynophagia and progressive dysphagia. Conclusion: Leishmaniasis should be suspected in all patients presenting with laryngeal symptoms in patients coming from endemic areas

Lobectomy versus total thyroidectomy in differentiated thyroid carcinoma: A review

BackgroundThyroid cancer is on the rise globally, there is increasing adoption of lobectomy for low-risk differentiated thyroid cancer.AimsThe current review aimed to assess lobectomy versus total thyroidectomy in low-risk differentiated thyroid carcinoma.Methods A systematic electronic search was conducted in the Pub Med and Google Scholar with no limitation of the period, 85 articles published in English were retrieved, two researchers screened the abstract for removal of duplications. Twenty-one articles fulfilled the inclusion and exclusion criteria.Results Among the twenty-one articles included (more than two-thirds were retrospective), eleven were from the USA, two from Europe, six from Asia, one from Canada and one from Australia. The results were mixed, some preferred lobectomy, others were on the side of total thyroidectomy, while some advised to weigh the risks and benefits.ConclusionThe results were mixed regarding the mode of surgery in low-risk differentiated thyroid cancer. Further, well-designed studies are needed to solve the current controversy

Pattern and temporal profile of thyroid carcinoma in the Kingdom of Saudi Arabia: A review and meta-analysis

BackgroundThere is an increasing rate of thyroid carcinoma in the developed world attributed mainly to over-diagnosis due to healthcare improvement. Saudi Arabia has made health a top priority, an increasing rate of over diagnosis is expected.AimsThe current review assessed the trends, spatial distribution, and epidemiology of thyroid carcinoma in the Kingdom of Saudi Arabia.Methods A systematic electronic search was conducted in PubMed and Google Scholar for relevant articles. All human studies published during the period 2009-December 2019 including Epub and ahead of print were eligible. The keywords thyroid carcinoma, thyroid lesion, Saudi Arabia, prevalence, and incidence were used in different combinations, among the three hundred fifty-four articles identified, twenty-three full text were assessed and only seventeen studies were included. Then the author's names, year and region of publication, the study type, period of study, and the result were recorded. The Statistical Package for Social Sciences (SPSS, IBM, version 20, New York was used for data analysis.Results Seventeen articles were included (9754 patient, age 44.53±5.42 years), women outmoded men and showed younger age (36.59 years), papillary carcinoma was the commonest sub-variant of carcinoma (75.62±17.53, age 52.3 years) followed by follicular (6.52±2.92).  An increasing trend was observed all over the Kingdom, but not consistent in all-region.ConclusionAn increasing rate of thyroid carcinoma was evident in the Kingdom of Saudi Arabia, the commonest being papillary carcinoma. Females were more commonly affected at a younger age group. Further National studies assessing whether the increased rate is due to over-diagnosis or other risk factors are highly recommended

The current state of knowledge regarding thyroid-stimulating hormone lowering/suppressive therapy and its cardiovascular risks in differentiated thyroid carcinoma

BackgroundThyroid-stimulating hormone acts as a growth factor for thyroid follicular cells, so some patients with differentiated thyroid carcinoma (DTC) are placed on thyroid hormone suppressive therapy. However, (TSH) suppression is not without risks.AimsWe thought to assess the potential benefits and cardiovascular risks among patients on TSH suppressive therapy following thyroid surgery for DTC.Methods A systematic electronic search was conducted in PubMed, MEDLINE, and Google Scholar for relevant articles. All human and cell lines studies published during the period 2009-October 2019 were eligible. The keywords TSH suppression, differentiated thyroid carcinoma, TSH level, cardiovascular risk, cardiovascular morbidity, cardiovascular mortality, atrial fibrillation, and left ventricular volume were used One hundred and eighty-five articles were retrieved and only eighteen met the inclusion and exclusion criteria.Results Out of 185 articles, eighteen studies were included, more than half (55.6 per cent)were published in Europe, 22.2 per cent were from Asia,11.1 per cent from Latin America and one study was from the USA, the majority (72.2 per cent were observational studies),. Patients on TSH suppression were at a high risk of cardiovascular morbidity and mortality that increases at lower TSH levels. Levels < .1mU/L are beneficial in patients with micro or macroscopic disease. However it may induce tumour growth among patients with aggressive recurrent disease, no benefit was observed in low-intermediate DTC.ConclusionPhysicians may need to suppress TSH in patients with micro or macroscopic DTC. However, caution is needed in aggressive recurrent disease. The available level of evidence showed no benefit of TSH lowering therapy in low-intermediate disease