Physician burnout syndrome

Background: The medical profession is the second largest official profession in Sudan. The fast spread of information technology in the eve of the second millennium has created an atmosphere of great expectations, that medical doctors should be updated, skillful, enthusiastic, kind, treat patients, train registrars teach medical students and develop high moral and ethical attitudes. Objectives: The purpose of this paper is to high light the Physician Burnout Syndrome and its relation to unintentional medical errors and society lack of satisfaction. Methods: Brief literature review and observations from the current atmosphere of medical practice in Sudan. Conclusion: Early detection is the responsibility of the administration and medical colleagues to save victims of the Physician Burnout Syndrome and prevent medical errors, unintentional laxity, disregard and/or malpractice.Key words: Physician burnout

Gastrointestinal Fistula: Audit of management in a remote hospital

Background: The management of gastrointestinal fistula continues to present considerable challenge to the surgeon in general and gastrointestinal surgeon in particular. Objectives: To audit the management and report the outcome of the gastrointestinal fistula in aremote hospital. Setup: Eldamazeen Hospital is a regional hospital in the Blue Nile state, south east of Sudan. Methods: Retrospective analysis of demographic and clinical data of patients with gastrointestinal fistula admitted to the surgical department in the period from Feb 2003 through Feb 2008. Results: 10(83.3%) patients had high out-put fistula. Two fistulas were complex and 10 were simple. The small intestine was the commonest site of fistula followed by the large bowel. The commonest causes of the gastrointestinal fistula are emergency operations for stab wounds, laparotomy and caesarean section. The overall mortality rate is 2(16, 7%) patients mainly due to inter-abdominal abscesses. Conclusion: Conservative treatment with nutritional support is the corner stay for successful treatment. However, early surgical management of septic foci should be considered.Keywords: Eldamazeen, laparotomy, caesarean, abscesses

Editorial – University Staff and Student Protection from COVID-19: Strategic Measures for Teaching and Learning in Resource-limited Setting

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Extraction of Pectin from Tamarind Fruits (Tamarindus indica L.) and its Utilization in Jam Production

     In the present work, pectin was extracted from tamarind fruit pulp and used for jam production. The pectin yield in one kg tamarind pulp was 3.7 grams. The average chemical composition of tamarind pulp was: 5.44 % protein, 2.44 % ash, 18.21 % moisture, 1.99 ± 0.8% fat, 13.05 ± 0.7% fiber and 55% available carbohydrates. The tamarind fruit pulp also contained appreciable amounts of minerals as follows: 134 (mg/100g) sodium, 74 (mg/100g) potassium and 88 (mg/100g) calcium. The chemical, microbiological and sensory quality characteristics of the extracted pectin jam (A) as well as commercial pectin jam (B) were also determined. (A) contained: 8.5 % total sugar, 5 % reducing sugar, 67 % total soluble solid, 36 mg/100g sodium, (60 mg/100g potassium, 80 mg/100g calcium and had a pH value of 3.3. On the other hand, (B) contained:    12 % total sugar, 1.3 % reducing sugar, 68 % total soluble solid, 44 (mg/100g) sodium, 43 (mg/100g) potassium, 64 (mg/100g) calcium and had a pH value of 3.5±0.1. Microbiological analysis of (B) had shown high levels of yeast and mould, however, the counts of yeast and mould was highly reduced in (A). The sensory analysis indicated that all types of jams were accepted by panelists who generally preferred (B) than (A) due to its appealing colour and flavour

Breaking Bad News for Patients with Gastro-Intestinal Malignancy: Experience at Ibn Sina Teaching Hospital

Background: Integrity, beneficence, non-maleficence and Justice are the pillars of the professional behaviour. Confidentiality is a serious issue governed by the law. However, in developing countries, patients’ relatives urge to know the diagnosis and often request the doctor not to mention the word cancer or malignancy to their patient.Objectives: To evaluate the communication skills for breaking bad news to Sudanese patients suffering of gastrointestinal cancer and to find out the patients’ responses on that matter.Materials and Methods: This is a hospital based non-randomized  prospective study, carried out at Ibn Sina Specialized Hospital in the period August through December 2011. The study involved113 patients of whom there were 56 males.Results: Doctors had talked about the disease to 75% of the patients  whereas the rest were told by either the psychologists and/or their  relatives. Only 25% of the patients were told the truth, the rest were told to have mass or lump without explaining its nature. Patients’ responses were as follows: 41.6% were felt terrified, 23.9% were shocked and became  anxious, while 33.6% were stable, but 0.9% became angry and frustrated. No patient was told about the prognosis and the chances of cure.Conclusion: Sympathy over-ride empathy in communicating bad news to Sudanese patients suffering of cancer. Patient education and training in breaking the bad news is needed.Key words: Communication skills, breaking bad news, truth telling, Sudan

Isolation and Identification of Bacterial Species from the Human Gallbladders Bile of Sudanese Patients

Background: Gallbladder infections are one of the most important problems that affect Sudanese patients.Objectives: To isolate bacterial species from infected human gallbladder's bile in Sudanese patients admitted for cholecystectomy due to calcoulus or acalcoulus cholecystitis.Materials and Methods: A total of 100 bile specimens from 100 patients (88 females and 12 males), were examined in this study. Bile specimens were collected from three different operating theatres including IbnSena Hospital, Sudan Private Clinic and Omdurman Teaching Hospital.Results: Six bacterial species were recognized in bile specimens, four of them are gramnegative and two are gram- positive species. In the present study, bacteria were isolated from 40 specimens out of the 100 bile specimens cultured with an overall incidence of 40%. It was noted that all positive bacterial bile cultures correlated with the presence of gallstones except three Salmonellae which were isolated from bile of acalculus gallbladders. The most prevalent bacteria isolated were E.coli which was isolated from 24 specimens out of the 100 bile specimens. On the other hand, Staphylococcus aureus and Pseudomonas spp. were less frequently isolated from bile specimens showing frequencies of 4 (4%) for each.Conclusion: The finding of this study indicated that Escherichia coli were the most prevalent bacteria which isolated from human bile. As well as, the study revealed that certain bacterial species such as Salmonellae possess characters which allow them to cause cholecystitis without need to gallstones formation.Key words: Gallbladder Bile, Bacterial isolates, Bile specimens, Cholecystectomy; Bacterial cholecystitis, Acalculus gallbladders

Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan

Background This article explores the hypothesis that predisposing and enabling factors of households influence the vaccination status of the children under the age of five in Khartoum State, Sudan. Method The study was a cross-sectional survey among a representative sample of 410 male and female children under five years of age from households with varying socio-economic status and mothers with varying levels of education, from both urban and rural localities in the state. Results The correct vaccination coverage rate for children was found to be high. Children in urban and rural areas differed substantially in their correct vaccination rates and their receipt of each vaccine separately. Walking or travelling time to the place of vaccination was found to be longer in rural areas when compared with urban areas. The vaccination rate increased with an increase in the age of the children and the education level of the mother. Children of older mothers were more likely to have had the correct vaccinations. The mothers\' knowledge of and attitudes to vaccination showed a strong relationship with the vaccination status of their children. When the coverage rate for each vaccine was taken separately, the economic level of the households significantly affected only the BCG vaccine coverage. Most vaccinations occurred in public outlet agencies. Conclusion The large differences found in vaccination coverage by place of residence and level of mother\'s education suggest that much greater efforts are required by the government if better rates of correct vaccination are to be achieved in rural areas. South African Family Practice Vol. 49 (8) 2007: pp. 1

Preliminary report on theNeurology workload ina central hospital in Sudan.

Introduction: Identification of the local pattern of neurological diseases is expected to help setting the priorities for good planning of management and public education.Objectives: To identify the pattern of neurological disorders in a second biggest central hospital in Sudan.Methodology: Review of the diagnosis of 170 patients, seen in the out patients neuro-clinic and the neurology ward from March 2010 to February 2011, was done. Patients who were in follow up by other neuro-clinics were excluded.Results: The male to female ratio was 1:1 Patients who were 20-60 years old comprised 54%.About 50% of patients live in Omdurman city. Motor symptoms were the most common presenting symptoms forming 64.1% followed by cranial nerves symptoms 27.6%. Stroke was the commonestencountered diagnosis seen in 20.7%, followed by epilepsy in 16.6%, headache in 9.6%, movement disorders in 7.7%, peripheral neuropathy in 3.6%, demylination in 1.8%, cerebral venous sinus thrombosis (CVST) 1.8% and tumours in 1.2% patients. Stroke was more common in patients from East Sudan and Epilepsy was more common in patients from West Sudan. Vascular and degenerative changes were the commonest abnormalities seen in imaging studies. Demyelination and neoplasms were more common in females.Conclusion: Stroke, epilepsy and headache were the commonest neurological disorders met in Omdurman Teaching Hospital.Key words: general hospital, neurology department, neurological disorders

Efficacy of Semi-Rigid Ureteroscopy and Holmium:YAG Laser Lithotripsy in the Treatment of Ureteric Calculi, a Retrospective Study

Background: Urolithiasis is a common worldwide health problem. Many endosurgical treatments became available for urinary calculi.Objectives: To find out the success clearance and complication rates of ureteric stone treatment using semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy as a day case procedure.Methods: In the period from April 2011 to October 2013, a total of 64 patients who were treated by laser lithotripsy were reviewed retrospectively using Fedail Hospital data. Diagnosis was radiologically confirmed. Semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy was conducted as a day case surgery. Operative details, clearance of stone fragments, failure and complications were analysed. Cases were followed clinically and radiologically after one week and one month.Results: The studied cases were 47 males and 17 females with average age of 47.3 years and ASA I in 52(81.3%). Those who had left ureteric stones were 28(43.8%) patients, only one patient had bilateral stones and 60(93.8%) patients had single stones. The largest stone diameter was 1.9cm. 68.8% had distal ureteric stones, 14.1% had mid third stones, and 17.2% had upper third stones. Most cases 96.9% were operated under spinal anaesthesia with mean operation time 61.2 minutes. Seven patients needed VUJ balloon dilatation to get access to the ureter.20 watt Holmium:YAG laser fibres were used for stone disintegration. 92.2% of cases had uncomplicated clearance, 3.1% minor complications and 4.7% failure of the procedure.100% clearance was confirmed during follow up. Conclusion: Semi-rigid ureteroscopy and Holmium:YAG laser lithotripsy is a safe treatment for ureteric calculi and can be conducted as a day case with high success rate and very low morbidity.Key words: ureteric stone, Semi-rigid ureteroscopy, Holmium:YAG laser lithotripsy

Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia

Background: Children with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations. Methods: We defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data. Results: By the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering. Conclusions: Children with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered