Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers

Elhadi Miskeen Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, Bisha, Saudi ArabiaCorrespondence: Elhadi Miskeen, Head Department of Obstetrics and Gynaecology, College of Medicine, University of Bisha, P.O. Box 1290, Bisha, 61922, Saudi Arabia, Email [email protected]: Utilizing antenatal care (ANC) is vital for maternal and neonatal well-being, especially in low-resource settings with healthcare challenges. Identifying factors impacting antenatal care this context, t of current situation in Sudan is crucial for developing strategies to improve maternal care. This study explores ANC utilization amidst COVID-19, security issues, and healthcare instability in primary health care centers in a resource-constrained environment, aiming to enhance maternal care access and quality.Methods: This is a mixed-methods study. Quantitative data were collected through a retrospective analysis of ANC attendance records before and during the pandemic. Demographic variables were analyzed for their association with ANC utilization. In-depth interviews were conducted to collect qualitative data from pregnant women and healthcare providers. These interviews focused on capturing the experiences, perceptions, and obstacles associated with antenatal care services during the pandemic and within the healthcare system challenges.Results: Preliminary quantitative analysis revealed a significant decline in ANC utilization during the pandemic. Fear of COVID-19 infection, disrupted transportation, and resource constraints have emerged as significant barriers to ANC attendance. The qualitative findings highlighted the impact of security challenges on healthcare access and the adaptation strategies employed, including mobile ANC clinics and telehealth consultations.Conclusion: This study illuminates the intricate landscape of ANC utilization in the face of a pandemic, security instability, and healthcare system vulnerability. Policymakers and stakeholders should collaborate to strengthen healthcare systems and ensure the continued provision of essential maternal health services during challenging times.Keywords: antenatal care, maternal health, COVID-19, healthcare system, primary health care centers, security challenges, low-resource country, healthcare acces

Audit of Extracorporeal Shockwave Lithotripsy in 210 Sudanese Patients at Gezera Hospital for Renal Diseases & Surgery (GHRD&S) Sudan

Background: Extracorporeal Shock Wave Lithotripsy (ESWL) was the breakthrough in urolithiasis management in the 20th century. Objectives: to audit the outcome of ESWL and evaluate its cost effectiveness on the treatment of stone disease in Gezira Hospital for Renal Disease and Surgery (GHRD&S), Sudan Methods: This is a prospective study of 210 patients. ESWL was performed with SLX MX STORZ machine. The number of shocks administered, and the degree of energy were supervised with maximum allowance of 2500-3000 shocks and 5-7 energy in kidney and/or 3000-3500 shock 7-8 energy level for ureteral stone with modification when it was indicated Results: Out of 210 patients; 28, 12, 28 and 2 patients had upper, mid, lower ureteric and vesical stones respectively. Where as 140 patients had renal stones. The success rate of fragmentation of the stones with ESWL was 97.1% for the renal, 92 % for the upper and lower ureter and 83.3% for mid ureteric stones. Vesical stones were not amenable for fragmentation in this study. The overall success rate was 95%. The complications were haematuria in one patient, pain and steinstrasse in two patients. There were no cases of post ESWL renal failure, hypertension and/or residual calculi. Conclusion: This modality of treatment was found to be less costly, acceptable with short hospital stay and short work absence. Keywords: Gezera, extracorporeal shockwave lithotripsy Sudan Journal of Medical Sciences Vol. 3 (1) 2008: pp. 11-1

Hemodialysis, plea of availability versus adequecy gezira experience

Objectives: This is a prospective cross sectional study carried out in Gezira Hospital for Renal Diseases and Surgery (Sudan) to assess the adequacy of hemodialysis in 206 patients with end stage kidney disease on regular hemodialysis twice per week using.Methods: Pre and post hemodialysis blood sample were obtained from the study group, spKt/V and urea reduction ratio were calculated.Results: Mean Kt/v was found to be 1.19 and urea reduction ratio was 59.55%. None of the patients in this study group achieved the National Kidney Foundation Dialysis Outcomes Quality Initiative (K/DOQI) recommendations for adequate hemodialyis, since it requiresthree hemodialyis sessions per week and our patients are receiving two sessions per week.Conclusion: In order to improve the situation herewith we recommended increased number of sessions from two to three times per week and \or increase the duration of hemodialysis session, increase blood flow rate and dialysate flow rate. Moreover, decrease the number of patients onregular hemodialysis by encouraging the patients to take the other renal replacement therapy (peritoneal dialysis and renal transplantations)

Detection of serum prostate specific antigen in lactating, pregnant, and advanced breast cancer Sudanese Women.

Introduction: Although prostate-specific antigen (PSA) is the most valuable tumor marker for the diagnosis and management of prostate carcinoma, it is widely accepted that PSA is not prostate specific.Objectives: The aim of this study is to address the possibility of using the PSA as marker for the sex assignment in different categories and relevance of this test in women problems.Method: We have evaluated the measurement of serum total PSA for differentiation between Sudanese women with advanced breast cancer (n= 10), and those are lactating (n=10), pregnant (n=10) compared with 20 healthy women as control group. Serum total PSA (TPSA) was measured using immuno-radiometric assay (IRMA).Results: In this study the mean age was significantly higher advanced breast cancer groups compared with lactating group (

The Anti-Inflammatory properties of interleukin 18 binding protein in rheumatoid arthritis

Objectives: Interleukin-18 binding protein (IL-18BP) is functioning as a natural anti-inflammatory and immunosuppressive molecule by neutralizing the effects of IL-18 during inflammation. This study aimed to identify the role of IL-18BPa in the regulation of immune responses associated with the pathogenesis of RA.Materials and Methods: 65 RA patients, 22 OA patients, and 40 sex and age matched healthy donors were enrolled in this study. Synovial specimens were obtained through synovectomy or arthroscopic procedures. SFMC and PBMC were prepared by using Ficoll-Hypaque separationprocedure. Superarray analysis was used to measure the expression profile of immune-related genes in normal PBMC treated with recombinant human IL-18BPa.The mRNA levels of Th1 and Th2 cytokines were measured by Real-time PCR, and the protein levels of IFN-ã, IL-4 were detected by ELISA.Results: SuperArray analysis of immune related gene expression profile in normal PBMC treated with IL-18BPa indicated decreases in the gene expression of IFN-ã and its regulatory molecules STAT-1 and STAT-2. This study pointed out that IL-18BPa has additional anti-inflammatory property through downregulating the expression of IFN-ã and IL-12, at the same time, upregulating the expression of IL-4 and IL-10. Both IFN-ã and IL-12 could upregulated the mRNA and protein levels of IL-18BPa in both the normal and RA subjects. Conclusion: Our results demonstrated the importance of IL-18BPa as an immune regulatory molecule and as a promising therapy for treating RA.Key words: IL-18BPa, Inflammation, Rheumatoid Arthritis, Osteoarthriti

Prostate Volume and PSA Cutoff Values as Predictive Indices for Success of Doxazocin Treatment in BPH in GHRDS

Background: Benign prostatic hyperplasia (BPH) is a non malignant enlargement of the prostate. This study was conducted to determine the pattern of presentation of BPH with and without acute urinary retention (AUR) and to determine the risk factors for acute urinary retention, in addition, to assess the results of doxazosin in the treatment of BPH with and without AUR.Patients and methods: Ninety two patients were enrolled in this study. All patients presented to the emergency department and the referred clinic of the Gezira Hospital for Renal Disease and Surgery (GHRDS) with lower urinary tract symptoms with and without acute urinary retention suggestive of BPH were evaluated according to the European guidelines. All of them underwent trans-rectal ultra sound and measurement for the prostatic volume. Serum PSA level was estimated. Doxazosin was given to all patients and they were followed for twelve weeks. A trial without acatheter at the end of the first week was attempted for patients with acute urinary retention. Results: The patients’ mean age ± SD at baseline was 67.8 ± 7.7 and 69.4 ± 9.9 for Non-AUR/BPH and AUR/BPH respectively. Comparing baseline clinical parameters of patients with and withoutacute urinary retention revealed that IPSS, prostate volume and PSA level are significantly different between the two groups with P< 0.01, 0.01 and 0.00 respectively. In the TWOC, 65% of patients passed urine spontaneously. By the end of the study, the overall response of patients showed 78.9% successful rate (n=73) and 21.1% failure rate (n=19). Prostatic volume and PSA level were found to affect doxazosin treatment significantly. With cutoff values of 41cc and (3.45) ng/ml, prostaticvolume and PSA level influenced doxazosin treatment failure.Conclusion: Serum PSA and prostate volume are powerful predictors of the risk of AUR. Alpha blockers are efficacious in treating retaining and non-retaining BPH patients. Knowledge of baseline serum PSA and/or prostate volume are useful tools to aid physicians and decision makersin predicting the risk of BPH-related outcomes and choosing dexazosin as therapy for BPH.Keywords: BPH, AUR, doxazosin, Sudanes

Prevalence of Depressive Symptoms and Its Correlates among Male Medical Students at the University of Bisha, Saudi Arabia

Background: Identifying the potential factors of depression among medical students is the first step towards academic excellence and future safe medical practice. Methods: A cross-sectional study was conducted from December 2019 to February 2020 at the University of Bisha, College of Medicine (UBCOM), Bisha Province, Saudi Arabia. Male medical students from year one to year six were involved. A self-administered questionnaire was used to collect data about students’ socio-demographic and academic characteristics. The Arabic version of the PHQ-9 scale with a score of ≥10 was used to identify depression. Logistic regression analysis was used to assess the prevalence and correlates of depression. Results: Of the 190 male students enrolled, 26.8% had depressive symptoms, of whom 45.1% were experiencing moderate to severe symptoms. The significantly highest depression rate was found among the second-year students, at 43.8% (OR = 2.544; 95% CI 1.178–5.714; p = 0.018), and the lowest rate was found among year one students, at 8.9% (OR = 0.203; 95% CI 0.075–0.560; p = 0.002). Univariate regression revealed a significant correlation between depression and dissatisfaction with family income, loss of family members, having psychological illness, difficulties in personal relationships, regretting studying medicine, failure in an academic year, a lower grade than expected, conflict with tutors, lack of college facilities and heavy academic load. In multivariate analysis, loss of family members (AOR = 3.69; 95% CI 1.86–7.413), difficulties in personal relationships (AOR = 2.371; 95% CI 1.009–5.575), regretting studying medicine (AOR = 3.764; 95% CI 1.657–8.550), and failing an academic year (AOR = 2.559; 95% CI 1.112–5.887) were independently correlated with depression. Conclusions: The study concluded that medical students at UBCOM experience depressive symptoms associated with various risk indicators. Optimizing the educational and social environment and infrastructure facilities at UBCOM might promote students’ mental health and well-being

An Exposition of Performance-Security Trade-offs in RANETs Based on Quantitative Network Models

NoSecurity mechanisms, such as encryption and authentication protocols, require extra computing resources and therefore, have an adverse effect upon the performance of robotic mobile wireless ad hoc networks (RANETs). Thus, an optimal performance and security trade-off should be one of the main aspects that should be taken into consideration during the design, development, tuning and upgrading of such networks. In this context, an exposition is initially undertaken on the applicability of Petri nets (PNs) and queueing networks (QNs) in conjunction with their generalisations and hybrid integrations as robust quantitative modelling tools for the performance analysis of discrete flow systems, such as computer systems, communication networks and manufacturing systems. To overcome some of the inherent limitations of these models, a novel hybrid modelling framework is explored for the quantitative evaluation of RANETs, where each robotic node is represented by an abstract open hybrid G-GSPN_QN model with head-of-line priorities, subject to combined performance and security metrics (CPSMs). The proposed model focuses on security processing and state-based control and it is based on an open generalised stochastic PN (GSPN) with a gated multi-class 'On-Off' traffic and mobility model. Moreover, it employs a power consumption model and is linked in tandem with an arbitrary QN consisting of finite capacity channel queues with blocking for 'intra' robot component-to-component communication and 'inter' robot-to-robot transmission. Conclusions and future research directions are included