The Antibiotic Resistance and Multidrug Resistance Pattern of Uropathogenic Escherichia coli at Soba University Hospital: A Descriptive Retrospective Survey

Background: The irrational use of antibiotics for the treatment of urinary tract infections (UTIs) may lead to increased antimicrobial resistance among uropathogenic Escherichia coli (E. coli), as well as multidrug resistance worldwide, which will limit available treatment options for UTIs caused by these organisms. This study aimed to determine the resistance pattern of E. coli causing UTIs in out-patients and in-patients of Soba University Hospital. Methods: Data were collected from the laboratory records in the Department of Microbiology in Soba Teaching Hospital by using a predesigned checklist and then analyzed using the statistical package for social sciences. Bivariate analysis (Chi-square test) was used to compare between variables. Results: Out of the 231 E. coli urine cultures, 160 (69.3%) were collected from females. The results showed high resistance to ampicillin (92.4%), amoxicillin-clavulanic acid (83.3%), cephalexin (90.6%), cefuroxime (72%), ceftazidime (71%), ceftriaxone (72%), ciprofloxacin (68%), and co-trimoxazole (75.3%). Collectively, around 188 (81.4%) were multidrug-resistant. On the other hand, the sensitivities of E. coli isolates were 68.8%, 93.1%, 89.4%, and 100% to gentamicin, amikacin, and carbapenems, respectively.  Conclusion: The rate of E. coli resistance was observed to be high to the commonly prescribed drugs for UTIs, including ampicillin, amoxicillin/clavulanic acid, different cephalosporins, fluoroquinolones, and co-trimoxazole. However, E. coli showed lower resistance rates to nitrofurantoin, amikacin, and carbapenems. Thus, these drugs can be reserved for the empirical treatment of UTIs caused by E. coli

Evaluation of the Adherence of Obstetricians to International Guidelines for Dispensing Misoprostol and Oxytocin in Saad Abu Ella Maternity Hospital: A Retrospective Study

Background: Misoprostol and oxytocin are commonly prescribed drugs by obstetricians to induce labor and prevent postpartum hemorrhage. In Sudan, there is no national guideline for prescribing these drugs. Thus, the prescribers follow the international guidelines. Hence, our study aimed to evaluate the adherence of Sudanese obstetricians to the international guidelines for dispensing misoprostol and oxytocin. Methods: A retrospective descriptive hospital-based study was performed at Saad Abu Ella hospital through their medical files archived in 2018 using a checklist designed by the researcher. Collected data were analyzed and presented in frequency tables using the statistical package for social sciences (SPSS). Results: A total of 357 medical files were evaluated, about 50% of cases examined was in the 25–35 years age range, multigravida pregnant ladies were 62%. General indications of oxytocin and/or misoprostol were induction of labor (17%), postpartum hemorrhage prevention (PPH) after normal vaginal delivery (NVD) (30%) and cesarean sections (32%), evacuation of incomplete miscarriage (20%), and termination of pregnancy (1%). Compared to the guidelines, only 14% were given the recommended regimens for labor induction; 9.4% of women who had undergone NVD were given the recommended regimen to prevent PPH. While, 57% and 43% of the cases with incomplete miscarriage and termination of pregnancy were given the recommended regimens, respectively. Based on the correct indication, total adherence was estimated to be 17%. Conclusions: Higher percentages of cases with incomplete miscarriage and intrauterine fetal death were given the recommended regimens to manage them. While, lower percentages of the participants were given the recommended regimens for labor induction and to prevent PPH.  Key words: misoprostol, oxytocin, obstetricians, adherence, international guideline

Adherence to Immunosuppressive Medications in Kidney Transplant Patients at Three Centers in Khartoum State, Sudan: A Cross-sectional Hospital Study

Background: Graft survival post-kidney transplantation is of paramount importance to patients and nephrologists. Nonadherence to immunosuppressive therapy can be associated with deterioration of renal function and graft rejection. This study aimed to evaluate the adherence to immunosuppressive medications in kidney transplant patients at three centers in Khartoum, Sudan. Methods: In this descriptive cross-sectional hospital-based survey, 277 post-kidneytransplant patients were recruited. Data were collected using a questionnaire and analyzed using the SPSS v.23. Our scoring method was calculated based on Morisky Medication Adherence Scale (MMAS-8) related to immunosuppressive medications and was expressed as questions in the questionnaire; every correct answer was given one mark, then the marks were gathered and their summation was expressed. Results: Overall, 33% ,45%, and 22% of the studied participants reported high, medium, and low adherence, respectively. The major factor for nonadherence was forgetfulness affecting 36.1% of those who did not adhere. The cost of the immunosuppressive medications did not negatively affect any of the participants’ adherence (100%). However, a significant association was seen between adherence and occupational status, duration of transplantation, shortage of immunosuppressants, recognizing the name of immunosuppressant, side effect, and forgetfulness (P-values = 0.002, 0.01, 0.006 , 0.000, 0.022, and 0.000, respectively). Logistic regression analysis showed a significant association with occupational status, side effects, and forgetfulness Conclusion: Only one-third of the participants were classed as “highly adherent” to their immunosuppressant medications. Factors that can affect adherence to immunosuppressant medications were occupational status, side effects, and forgetfulness

The Impact of Clinical Pharmacist Diabetes Education on Medication Adherence in Patients with Type 2 Diabetes Mellitus: An Interventional Study from Khartoum, Sudan

Background: Continuous therapeutic care with good medication adherence is the cornerstone of management of all chronic diseases including diabetes. This study aimed to evaluate the impact of clinical pharmacist intervention on the medication adherence in individuals with type 2 diabetes (T2DM). Methods: This was a randomized, double-blind, controlled trial conducted at a diabetes clinic located at Omdurman Military Hospital, Sudan. Individuals with T2DM attending the diabetes clinic within 1 year were selected. The sample size was 364 participants (182 control and 182 interventional group). We used a pre-structured standardized questionnaire and checklist to collect the data. Data were analyzed by using the Statistical Package for the Social Sciences (SPSS) (version 28). Results: Majority, 76.4% (n = 278) were females, and they consisted of 80.8% (n = 147) of the interventional group and 72% of the controls. The mean age of the interventional group was 54.5 (±10) years; 31.9% (n = 58) of the interventional group had diabetes for 6–10 years, compared with 26.4% (n = 48) of the control group. Among the control group, the mean adherence score was 6.8 (±1.7) at baseline and it was 6.7 (±1.6) at the end of the study (p < 0.001), while in the interventional group, the mean adherence score was 6.8 (±1.7) at baseline and it was 7.4 (±1.5) at the end of the study (p < 0.001). Conclusion: Adherence score among the intervention group was increased significantly from baseline to the end of the study when compared to the control group.Scopu

Knowledge and attitudes toward COVID-19 vaccination in Sudan: A cross-sectional study

Background: Vaccines are an essential part of public health interventions to mitigate the devastating health and non-health impacts of COVID-19 pandemic. Despite the fact that Sudan launched the COVID-19 vaccination program in March 2021, only 10% of the population received their two primary doses of vaccines by the end of May 2022. This delayed uptake of vaccines obviously warrants investigation. Therefore, we have conducted this study to evaluate the knowledge, attitude and acceptance of the general population in Sudan toward COVID-19 vaccines. Methodology: A descriptive cross-sectional community-based study. The data were collected using an electronic questionnaire from 403 individuals living in Khartoum, Sudan. The data were processed using the Statistical Package for Social Sciences (SPSS), and data analysis was performed using appropriate tests. Results: 51% of the participants were found to have sufficient knowledge about the COVID-19 vaccine, and the knowledge level is higher among those educated beyond the secondary school and those who were employed. Among those unvaccinated, only 47% of the participants expressed their intention to take the vaccine when offered to them. The major reason for not trusting the vaccine is safety concerns expressed by 65.5% of the unvaccinated. Conclusion: Higher education levels and employment were associated with an increase in sufficient knowledge about the vaccine in around half of the participants. However, most of participants had not taken the vaccine at the time of the study, and the trust in vaccines is not high. Effective interventions by the health authorities are needed to address these issues in order to accelerate the COVID-19 vaccination program in Sudan

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The Antibiotic Resistance and Multidrug Resistance Pattern of Uropathogenic Escherichia Coli at Soba University Hospital: A Descriptive Retrospective Survey

Background:&nbsp;The irrational use of antibiotics for the treatment of urinary tract infections (UTIs) may lead to increased antimicrobial resistance among uropathogenic&nbsp;Escherichia coli&nbsp;(E. coli), as well as multidrug resistance worldwide, which will limit available treatment options for UTIs caused by these organisms.&nbsp;This study aimed to determine the resistance pattern of&nbsp;E. coli&nbsp;causing UTIs in out-patients and in-patients of Soba University Hospital. Methods:&nbsp;Data were collected from the laboratory records in the Department of Microbiology in Soba Teaching Hospital by using a predesigned checklist and then analyzed using the statistical package for social sciences. Bivariate analysis (Chi-square test) was used to compare between variables. Results:&nbsp;Out of the 231&nbsp;E. coli&nbsp;urine cultures, 160 (69.3%) were collected from females. The results showed high resistance to ampicillin (92.4%), amoxicillin-clavulanic acid (83.3%), cephalexin (90.6%), cefuroxime (72%), ceftazidime (71%), ceftriaxone (72%), ciprofloxacin (68%), and co-trimoxazole (75.3%). Collectively, around 188 (81.4%) were multidrug-resistant. On the other hand, the sensitivities of&nbsp;E. coli&nbsp;isolates were 68.8%, 93.1%, 89.4%, and 100% to gentamicin, amikacin, and carbapenems, respectively.&nbsp; Conclusion:&nbsp;The rate of&nbsp;E. coli&nbsp;resistance was observed to be high to the commonly prescribed drugs for UTIs, including ampicillin, amoxicillin/clavulanic acid, different cephalosporins, fluoroquinolones, and co-trimoxazole. However,&nbsp;E. coli&nbsp;showed lower resistance rates to nitrofurantoin, amikacin, and carbapenems. Thus, these drugs can be reserved for the empirical treatment of UTIs caused by&nbsp;E. coli

Evaluation of the Adherence of Obstetricians to International Guidelines for Dispensing Misoprostol and Oxytocin in Saad Abu Ella Maternity Hospital: A Retrospective Study

Background:&nbsp;Misoprostol and oxytocin are commonly prescribed drugs by obstetricians to induce labor and prevent postpartum hemorrhage. In Sudan, there is no national guideline for prescribing these drugs. Thus, the prescribers follow the International guidelines. Hence, our study aimed to evaluate the adherence of Sudanese obstetricians to the International guidelines for dispensing misoprostol and oxytocin. Methods:&nbsp;A retrospective descriptive hospital-based study was performed at Saad Abu Ella hospital through their medical files archived in 2018 using a checklist designed by the researcher. Collected data were analyzed and presented in frequency tables using the statistical package for social sciences (SPSS). Results:&nbsp;A total of 357 medical files were evaluated, about 50% of cases examined was in the 25–35 years age range, multigravida pregnant ladies were 62%. General indications of oxytocin and/or misoprostol were induction of labor (17%), postpartum hemorrhage prevention (PPH) after normal vaginal delivery (NVD) (30%) and cesarean sections (32%), evacuation of incomplete miscarriage (20%), and termination of pregnancy (1%). Compared to the guidelines, only 14% were given the recommended regimens for labor induction; 9.4% of women who had undergone NVD were given the recommended regimen to prevent PPH. While, 57% and 43% of the cases with incomplete miscarriage and termination of pregnancy were given the recommended regimens, respectively. Based on the correct indication, total adherence was estimated to be 17%. Conclusions:&nbsp;Higher percentages of cases with incomplete miscarriage and intrauterine fetal death were given the recommended regimens to manage them. While, lower percentages of the participants were given the recommended regimens for labor induction and to prevent PPH.&nbsp; Key words:&nbsp;misoprostol, oxytocin, obstetricians, adherence, International guideline

Knowledge, Prevalence and Practice of Polycystic Ovary Syndrome among Sudanese women in Khartoum State, Sudan: The need for health education

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and cause of infertility in women of reproductive age. Knowledge of females about health problems is considered an important factor that promotes females’ health-seeking behavior. This study aimed to evaluate females’ knowledge and attitude toward PCOS as well as to assess PCOS prevalence among the participants. Methods: A total of 240 females were included in the study between January and April 2019. A convenience sampling technique was used to select the participants. Data were collected using a self-administered questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 24. The analysis included frequencies of discrete variables and descriptors and cross-tabulation of the variables using the Chi-square test and logistic regression analysis. P &lt; 0.05 was considered statistically significant. Results: The results showed a low level of knowledge (scoring &lt;9) in 41.3%, a good level (scoring between 9 and 15) in 21.3%, and also an excellent level of knowledge (scoring &gt;15) in 37.5%. The Chi-square statistical test showed significant associations between the level of knowledge and education level, urban residence, health profession, marital status, and the prevalence of PCOS (p &lt; 0.001, &lt;0.001, &lt;0.001, 0.045, and &lt;0.001), respectively. Logistic regression showed that the females’ knowledge about PCOS was significantly associated with urban residence and being a health professional (p = 0.004 and p &lt; 0.001, respectively). Conclusion: The study highlighted that there was inadequate knowledge about the disease among participants and showed an urgent need to improve the knowledge about PCOS among Sudanese women

Knowledge and practice about mycetoma infection among community pharmacists in Khartoum State: A descriptive cross-sectional study

Mycetoma is classified as a neglected tropical disease, and despite its spread in Sudan, most physicians and pharmacists do not pay attention to the symptoms and proper treatment of mycetoma. Thus, this study aimed to evaluate knowledge and practice on mycetoma among community pharmacists in Khartoum state. A cross-sectional descriptive study was carried out among community pharmacists in Khartoum state, in the period from August to October 2021. Data was collected from the seven localities within Khartoum state using a validated self-administered questionnaire. The knowledge and practice of community pharmacists were assessed, and their association with demographic characteristics was calculated. Out of 347 pharmacists, 59.9% were females, 64.8% were between 22 and 28 years of age, and 79.3% were bachelor holders. Most of the participants (52.7%) had sufficient knowledge about mycetoma, the most common source of information was lectures (36.6%), more than half participants heard about the Mycetoma Research Center, and most of the cases seen by the participants were in the community (30.5%). There was no association between demographic data and knowledge score, except for knowing about the Mycetoma Research Center and attending workshops and seminars. Moreover, more than half of the participants showed good practice with mycetoma patients. The findings of the current study reflect that more efforts are needed to increase the knowledge and improve the practice of community pharmacists toward mycetoma